Abstract Pediatric Microcuff endotracheal tubes have come into vogue in the last few years. It overcomes the problems faced with the uncuffed or conventional cuffed tubes used in the pediatric population. In addition, the more distal placement of the polyurethane cuffs in these tubes eliminates the risk of airway mucosal injury and hence postoperative stridor. This makes it an attractive option for neurosurgical patients where there is a high incidence of cranial nerve deficit, airway edema, and the requirement of prolonged postoperative ventilation. But due to this particular design, Murphy's eye is not incorporated in the tube, which can potentially hamper ventilation, especially when used for long duration surgery. With the help of our case report, we would like to warn the readers regarding this life-threatening complication that resulted in hypoxia in a 1-year-old child in the postoperative period.
{"title":"Pediatric Microcuff Tube for Neurosurgical Procedures: A Boon or Bane?","authors":"Keta D. Thakkar, M. Sethuraman, A. Hrishi","doi":"10.1055/s-0042-1750092","DOIUrl":"https://doi.org/10.1055/s-0042-1750092","url":null,"abstract":"Abstract Pediatric Microcuff endotracheal tubes have come into vogue in the last few years. It overcomes the problems faced with the uncuffed or conventional cuffed tubes used in the pediatric population. In addition, the more distal placement of the polyurethane cuffs in these tubes eliminates the risk of airway mucosal injury and hence postoperative stridor. This makes it an attractive option for neurosurgical patients where there is a high incidence of cranial nerve deficit, airway edema, and the requirement of prolonged postoperative ventilation. But due to this particular design, Murphy's eye is not incorporated in the tube, which can potentially hamper ventilation, especially when used for long duration surgery. With the help of our case report, we would like to warn the readers regarding this life-threatening complication that resulted in hypoxia in a 1-year-old child in the postoperative period.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"201 - 203"},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46518697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The determination of extubation (early or delayed) after pediatric craniotomy for intracranial tumor should be carefully considered because each has its pros and cons. The aim of this study was to investigate the incidence of the delayed extubation in these patients. The secondary goal was to identify the perioperative factors influencing the determination of delayed extubation. Methods This retrospective study was performed in pediatric patients with intracranial tumor who underwent craniotomy at a university hospital between April 2010 and March 2020. Preoperative and intraoperative variables were examined. The variables were compared between the delayed extubation and early extubation group. Results Forty-two of 286 pediatric patients were in the delayed extubation group with an incidence of 14.69%. According to multivariate analyses, the risk factors that prompted delayed extubation were the intracranial tumor size ≥ 55 mm (adjusted odds ratio [AOR], 2.338; 95% confidence interval [CI], 1.032–5.295; p = 0.042), estimated blood loss (EBL) ≥ 40% of calculated blood volume (AOR, 11.959; 95% CI, 3.457–41.377; p < 0.001), blood transfusion (AOR, 3.093; 95% CI, 1.069–8.951; p = 0.037), duration of surgery ≥ 300 minutes (AOR, 2.593; 95% CI, 1.099–6.120; p = 0.030), and completion of the operation after working hours (AOR, 13.832; 95% CI, 2.997–63.835; p = 0.001). Conclusions The incidence of delayed extubation after pediatric craniotomy was 14.69%. The predictive factors were the size of tumor ≥ 55 mm, EBL ≥ 40% of calculated blood volume, blood transfusion, duration of surgery ≥ 300 minutes, and completion of surgery after routine working hours.
{"title":"Incidence and Perioperative Risk Factors of Delayed Extubation following Pediatric Craniotomy for Intracranial Tumor: A 10-Year Retrospective Analysis in a Thailand Hospital","authors":"Sunisa Sangtongjaraskul, Kornkamon Yuwapattanawong, Vorrachai Sae-Phua, Thichapat Jearranaiprepame, Paweena Paarporn","doi":"10.1055/s-0042-1750421","DOIUrl":"https://doi.org/10.1055/s-0042-1750421","url":null,"abstract":"Abstract Background The determination of extubation (early or delayed) after pediatric craniotomy for intracranial tumor should be carefully considered because each has its pros and cons. The aim of this study was to investigate the incidence of the delayed extubation in these patients. The secondary goal was to identify the perioperative factors influencing the determination of delayed extubation. Methods This retrospective study was performed in pediatric patients with intracranial tumor who underwent craniotomy at a university hospital between April 2010 and March 2020. Preoperative and intraoperative variables were examined. The variables were compared between the delayed extubation and early extubation group. Results Forty-two of 286 pediatric patients were in the delayed extubation group with an incidence of 14.69%. According to multivariate analyses, the risk factors that prompted delayed extubation were the intracranial tumor size ≥ 55 mm (adjusted odds ratio [AOR], 2.338; 95% confidence interval [CI], 1.032–5.295; p = 0.042), estimated blood loss (EBL) ≥ 40% of calculated blood volume (AOR, 11.959; 95% CI, 3.457–41.377; p < 0.001), blood transfusion (AOR, 3.093; 95% CI, 1.069–8.951; p = 0.037), duration of surgery ≥ 300 minutes (AOR, 2.593; 95% CI, 1.099–6.120; p = 0.030), and completion of the operation after working hours (AOR, 13.832; 95% CI, 2.997–63.835; p = 0.001). Conclusions The incidence of delayed extubation after pediatric craniotomy was 14.69%. The predictive factors were the size of tumor ≥ 55 mm, EBL ≥ 40% of calculated blood volume, blood transfusion, duration of surgery ≥ 300 minutes, and completion of surgery after routine working hours.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"155 - 161"},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48613748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ankur Khandelwal, S. Nayak, Anshil Bhatia, Amit K. Shrivastava, Vikas Bhardwaj
Abstract Venous air embolism (VAE), though, clinically benign in majority of cases, the significant ones can lead to life-threatening cardiopulmonary and neurological consequences. Though studies mention the success rate of only 6 to 16% in aspirating air from the central venous catheter (CVC) during VAE, the technique is very specific for diagnosing VAE and has high therapeutic significance. We report a case in which delayed aspiration of air emboli from the CVC in suspected massive VAE during decompressive craniectomy resulted in rapid resolution of hemodynamic instability. If not inserted previously, CVC may be considered in a hemodynamically unstable patient with suspected VAE.
{"title":"Delayed Aspiration of Air Emboli from the Central Venous Catheter in a Case of Suspected Massive Venous Air Embolism: A Therapeutic Success","authors":"Ankur Khandelwal, S. Nayak, Anshil Bhatia, Amit K. Shrivastava, Vikas Bhardwaj","doi":"10.1055/s-0042-1748840","DOIUrl":"https://doi.org/10.1055/s-0042-1748840","url":null,"abstract":"Abstract Venous air embolism (VAE), though, clinically benign in majority of cases, the significant ones can lead to life-threatening cardiopulmonary and neurological consequences. Though studies mention the success rate of only 6 to 16% in aspirating air from the central venous catheter (CVC) during VAE, the technique is very specific for diagnosing VAE and has high therapeutic significance. We report a case in which delayed aspiration of air emboli from the CVC in suspected massive VAE during decompressive craniectomy resulted in rapid resolution of hemodynamic instability. If not inserted previously, CVC may be considered in a hemodynamically unstable patient with suspected VAE.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"198 - 200"},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41939244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thanawut Jitsinthunun, M. Raksakietisak, Chanitda Pantubtim, Porntip Mahatnirunkul
Abstract Background Meningioma brain tumor is associated with significant blood loss. Magnesium (Mg), a calcium blocker, can facilitate blood pressure control during surgery. This study aimed to evaluate effects of magnesium on blood loss, anesthetic requirement, and its neuroprotective effect in meningioma patients undergoing craniotomy. Methods Eighty patients aged between 18 and 70, American Society of Anesthesiologists physical status I and II, diagnosed with meningioma and scheduled for craniotomy tumor removal were randomized into two groups. Group M (Mg) received intravenous magnesium sulfate 40 mg/kg over 30 minutes initiated at skin incision and followed by continuous infusion of 10 mg/kg/h until dura closure. Group N (NSS) received 0.9% NaCl as placebo. Anesthesiologists in charge, surgeons, and patients were all blinded. The assessed outcomes were perioperative blood loss, anesthetic requirement, and pre- and postoperative neurocognitive functions assessed by Montreal Cognitive Assessment (MoCA). Results Thirty-eight patients in each group were analyzed. In group M, the intraoperative blood losses were 500 (70, 2300) mL, and 510 (100, 1600) mL in group N ( p = 0.315). Patients who received blood within 24 hours were 39.5% in group M and 47.4% in group N ( p = 0.644). No differences were observed in anesthetic requirement, intraoperative mean arterial pressure, hypotensive episodes, and vasopressor usages. There were no significant differences in postoperative MoCA score. Magnesium levels did not exceed acceptable levels. Conclusions Magnesium administration in meningioma patients had no significant effects on blood loss, anesthetic requirement, and postoperative cognitive function.
{"title":"Effects of Magnesium Sulfate on Intraoperative Blood Loss and Anesthetic Requirement in Meningioma Patients Undergoing Craniotomy with Tumor Removal: A Prospective Randomized Study","authors":"Thanawut Jitsinthunun, M. Raksakietisak, Chanitda Pantubtim, Porntip Mahatnirunkul","doi":"10.1055/s-0042-1750692","DOIUrl":"https://doi.org/10.1055/s-0042-1750692","url":null,"abstract":"Abstract Background Meningioma brain tumor is associated with significant blood loss. Magnesium (Mg), a calcium blocker, can facilitate blood pressure control during surgery. This study aimed to evaluate effects of magnesium on blood loss, anesthetic requirement, and its neuroprotective effect in meningioma patients undergoing craniotomy. Methods Eighty patients aged between 18 and 70, American Society of Anesthesiologists physical status I and II, diagnosed with meningioma and scheduled for craniotomy tumor removal were randomized into two groups. Group M (Mg) received intravenous magnesium sulfate 40 mg/kg over 30 minutes initiated at skin incision and followed by continuous infusion of 10 mg/kg/h until dura closure. Group N (NSS) received 0.9% NaCl as placebo. Anesthesiologists in charge, surgeons, and patients were all blinded. The assessed outcomes were perioperative blood loss, anesthetic requirement, and pre- and postoperative neurocognitive functions assessed by Montreal Cognitive Assessment (MoCA). Results Thirty-eight patients in each group were analyzed. In group M, the intraoperative blood losses were 500 (70, 2300) mL, and 510 (100, 1600) mL in group N ( p = 0.315). Patients who received blood within 24 hours were 39.5% in group M and 47.4% in group N ( p = 0.644). No differences were observed in anesthetic requirement, intraoperative mean arterial pressure, hypotensive episodes, and vasopressor usages. There were no significant differences in postoperative MoCA score. Magnesium levels did not exceed acceptable levels. Conclusions Magnesium administration in meningioma patients had no significant effects on blood loss, anesthetic requirement, and postoperative cognitive function.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"168 - 176"},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44138489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Sipahioğlu, Gulseren Elay, Nezahat Bingol, I. Bahar
Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.
{"title":"Retrospective Analysis of 1998 Patients Diagnosed with Brain Death between 2011 and 2019 in Turkey","authors":"H. Sipahioğlu, Gulseren Elay, Nezahat Bingol, I. Bahar","doi":"10.1055/s-0042-1750093","DOIUrl":"https://doi.org/10.1055/s-0042-1750093","url":null,"abstract":"Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45601604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The anesthetic management of a type-2 neurofibromatosis patient with a difficult airway is quite challenging. Such a situation tests the limits of the anesthesiologist's preparedness in maintaining the balance of the cerebral protection strategies and securing the airway. The anticipated challenges include managing the airway, controlling the raised intracranial pressure, and maintaining stable hemodynamics in anticipation of the expected blood loss. This article focuses on the preoperative airway evaluation and intraoperative preparedness in case of a patient with type-2 neurofibromatosis scheduled for craniotomy and excision of intracranial meningioma.
{"title":"Type-2 Neurofibromatosis Patient with Parasagittal Meningioma: A Challenging Airway","authors":"Aparna Depuru, A. Barik, K. Jangra, N. Panda","doi":"10.1055/s-0042-1745724","DOIUrl":"https://doi.org/10.1055/s-0042-1745724","url":null,"abstract":"Abstract The anesthetic management of a type-2 neurofibromatosis patient with a difficult airway is quite challenging. Such a situation tests the limits of the anesthesiologist's preparedness in maintaining the balance of the cerebral protection strategies and securing the airway. The anticipated challenges include managing the airway, controlling the raised intracranial pressure, and maintaining stable hemodynamics in anticipation of the expected blood loss. This article focuses on the preoperative airway evaluation and intraoperative preparedness in case of a patient with type-2 neurofibromatosis scheduled for craniotomy and excision of intracranial meningioma.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"195 - 197"},"PeriodicalIF":0.0,"publicationDate":"2022-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43242405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mallikarjuna, N. Ramakumar, B. Gupta, S. Chakraborty
Intraoperative imaging is a ubiquitous tool in neurosurgery, cranial and spinal procedures. Mobius Airo TruCT (Shirley, Massachusetts, United States) is the largest inner bore, mobile intraoperative computed tomography (CT) imaging system that seamlessly integrates into an operating room (OR) setup. 1 In transport mode, the ring is aligned with the base, and the scanner moves on the ramp to the desired location for scanning of the operative site. An intraoperative imaging system that gives high-quality images and a wide fi eld of vision in both two- and three dimensions is provided by this device. There are few reports on use of intraoperative CT in neurosurgery and spine surgeries. 2 – 4 There is a paucity of literature on the ergonomics of CT scanner location, anesthetic workstation placement, and patient alignment for CT-guided neuronavigation, or scanning from an anesthesiologist point of view; we found it worthwhile to share our limited experience.
术中成像在神经外科、颅脑和脊柱手术中是一种无处不在的工具。Mobius Airo TruCT (Shirley, Massachusetts, United States)是最大的内孔移动术中计算机断层扫描(CT)成像系统，可无缝集成到手术室(OR)设置中。1 .在运输模式下，环与底座对齐，扫描仪在斜坡上移动到所需位置，对操作部位进行扫描。该设备提供了一种术中成像系统，可提供高质量的图像和二维和三维的宽视野。术中CT在神经外科和脊柱外科的应用鲜有报道。2 - 4从麻醉师的角度来看，缺乏关于CT扫描仪位置、麻醉工作站位置和CT引导神经导航的患者对齐的人体工程学文献;我们觉得分享我们有限的经验是值得的。
{"title":"Mobius Airo TruCT Scanner in the Operating Room: An Ergonomic Challenge to Neuroanesthesiologist","authors":"S. Mallikarjuna, N. Ramakumar, B. Gupta, S. Chakraborty","doi":"10.1055/s-0042-1744401","DOIUrl":"https://doi.org/10.1055/s-0042-1744401","url":null,"abstract":"Intraoperative imaging is a ubiquitous tool in neurosurgery, cranial and spinal procedures. Mobius Airo TruCT (Shirley, Massachusetts, United States) is the largest inner bore, mobile intraoperative computed tomography (CT) imaging system that seamlessly integrates into an operating room (OR) setup. 1 In transport mode, the ring is aligned with the base, and the scanner moves on the ramp to the desired location for scanning of the operative site. An intraoperative imaging system that gives high-quality images and a wide fi eld of vision in both two- and three dimensions is provided by this device. There are few reports on use of intraoperative CT in neurosurgery and spine surgeries. 2 – 4 There is a paucity of literature on the ergonomics of CT scanner location, anesthetic workstation placement, and patient alignment for CT-guided neuronavigation, or scanning from an anesthesiologist point of view; we found it worthwhile to share our limited experience.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43394567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siddharth Chavali, Subodh Raju, Suresh Kanasani, Abhirama C Gabbita
Abstract The Bombay blood group is an extremely rare entity within the conventional ABO blood grouping system. End-stage liver disease also presents with myriad disorders of coagulation due to impaired synthesis and dysfunction of clotting factors, which predisposes patients to spontaneous and life-threatening episodes of bleeding. We report a patient with Bombay blood group and end-stage liver disease who presented to our hospital with a spontaneous subdural hematoma. Although conventional parameters of coagulation in this patient were abnormal, we were able to safely defer product transfusion because his thromboelastography (TEG) report was within acceptable ranges. In this article, we discuss our strategy for optimization of extremely limited blood resources in this scenario and perioperative strategies for the management of coagulation anomalies in patients with liver dysfunction.
{"title":"Management of a Patient with Bombay Blood Group and Chronic Liver Disease with Subdural Hematoma","authors":"Siddharth Chavali, Subodh Raju, Suresh Kanasani, Abhirama C Gabbita","doi":"10.1055/s-0042-1744402","DOIUrl":"https://doi.org/10.1055/s-0042-1744402","url":null,"abstract":"Abstract The Bombay blood group is an extremely rare entity within the conventional ABO blood grouping system. End-stage liver disease also presents with myriad disorders of coagulation due to impaired synthesis and dysfunction of clotting factors, which predisposes patients to spontaneous and life-threatening episodes of bleeding. We report a patient with Bombay blood group and end-stage liver disease who presented to our hospital with a spontaneous subdural hematoma. Although conventional parameters of coagulation in this patient were abnormal, we were able to safely defer product transfusion because his thromboelastography (TEG) report was within acceptable ranges. In this article, we discuss our strategy for optimization of extremely limited blood resources in this scenario and perioperative strategies for the management of coagulation anomalies in patients with liver dysfunction.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"192 - 194"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43318266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sean M. Mock, Hannah Harris, T. Kane, John M. Dunford
Central cord syndrome is a form of incomplete spinal cord injury appearing in the anesthesia literature primarily in trauma. Our institution recently managed a rare, life-threatening central cord syndrome following an uneventful anterior cervical discectomy and fusion which uniquely presented as respiratory depression progressing to quadriplegia. This patient's dramatic experience began nearly indistinguishably from more common etiologies of respiratory depression in the post-anesthesia care unit before blossoming swiftly into quadriplegia. We review the details of her presentation and pathophysiology with a message of vigilance to the anesthesia provider. Interpretation of her clinical exam and rapid intervention were key to preventing a lethal outcome. Central cord syndrome should be considered by anesthesiologists in the differential for respiratory depression following cervical spine surgery.
{"title":"Postoperative Central Cord Syndrome: Physiologic Decapitation in the PACU","authors":"Sean M. Mock, Hannah Harris, T. Kane, John M. Dunford","doi":"10.1055/s-0042-1744397","DOIUrl":"https://doi.org/10.1055/s-0042-1744397","url":null,"abstract":"Central cord syndrome is a form of incomplete spinal cord injury appearing in the anesthesia literature primarily in trauma. Our institution recently managed a rare, life-threatening central cord syndrome following an uneventful anterior cervical discectomy and fusion which uniquely presented as respiratory depression progressing to quadriplegia. This patient's dramatic experience began nearly indistinguishably from more common etiologies of respiratory depression in the post-anesthesia care unit before blossoming swiftly into quadriplegia. We review the details of her presentation and pathophysiology with a message of vigilance to the anesthesia provider. Interpretation of her clinical exam and rapid intervention were key to preventing a lethal outcome. Central cord syndrome should be considered by anesthesiologists in the differential for respiratory depression following cervical spine surgery.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47596295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bindra, S. Bharadwaj, Nitasha Mishra, D. Masapu, S. Bhargava, A. Luthra, M. Marda, A. Hrishi, H. Bhagat, P. Bidkar, Ponniah Vanamoorthy, Zulfiqar Ali, M. Khan
Background A questionnaire-based survey was conducted to determine the preanesthetic evaluation (PAE) practices among the members of the Indian Society of Neuroanesthesiology and Critical Care (ISNACC). The survey aimed to assess the current clinical practice of PAE and optimization of neurosurgical patients in India. Methods An online questionnaire was designed by the working group of ISNACC and circulated among its active members. Response to individual questions was considered significant if 50% or more respondents concurred. The survey questions to which less than 50% of respondents concurred were identified as inconclusive results. Results Out of 438 active ISNACC members, 218 responded. Responses were obtained from various parts of the country. The majority of participants were practicing neuroanesthesiology. Questions asked were regarding clinical assessment, preoperative optimization, prognostication, and airway management in neurosurgery. More than 50% of practitioners acceded to most of the questions; however, the percentage of responses varied across different questions (50–100%). The questions related to preoperative duplex scanning in chronically immobilized patients, preoperative cognitive testing, and risk stratification during neurosurgical procedures received an inconclusive response (< 50%). Conclusion The survey highlights the variable PAE practices perused by ISNACC members across the country. A guideline for uniform PAE practices may help to enhance research and improve perioperative care.
{"title":"Preanesthetic Evaluation and Preparation for Neurosurgical Procedures: An Indian Perspective","authors":"A. Bindra, S. Bharadwaj, Nitasha Mishra, D. Masapu, S. Bhargava, A. Luthra, M. Marda, A. Hrishi, H. Bhagat, P. Bidkar, Ponniah Vanamoorthy, Zulfiqar Ali, M. Khan","doi":"10.1055/s-0042-1749649","DOIUrl":"https://doi.org/10.1055/s-0042-1749649","url":null,"abstract":"\u0000 Background A questionnaire-based survey was conducted to determine the preanesthetic evaluation (PAE) practices among the members of the Indian Society of Neuroanesthesiology and Critical Care (ISNACC). The survey aimed to assess the current clinical practice of PAE and optimization of neurosurgical patients in India.\u0000 Methods An online questionnaire was designed by the working group of ISNACC and circulated among its active members. Response to individual questions was considered significant if 50% or more respondents concurred. The survey questions to which less than 50% of respondents concurred were identified as inconclusive results.\u0000 Results Out of 438 active ISNACC members, 218 responded. Responses were obtained from various parts of the country. The majority of participants were practicing neuroanesthesiology. Questions asked were regarding clinical assessment, preoperative optimization, prognostication, and airway management in neurosurgery. More than 50% of practitioners acceded to most of the questions; however, the percentage of responses varied across different questions (50–100%). The questions related to preoperative duplex scanning in chronically immobilized patients, preoperative cognitive testing, and risk stratification during neurosurgical procedures received an inconclusive response (< 50%).\u0000 Conclusion The survey highlights the variable PAE practices perused by ISNACC members across the country. A guideline for uniform PAE practices may help to enhance research and improve perioperative care.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44132467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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