Balaji Vaithialingam, Mouleeswaran Sundaram, V. Bhadrinarayan
Horner ’ s syndrome is a rare phenomenon associated with a wide variety of medical and surgical conditions. Ipsilateral ptosis and miosis occur in Horner ’ s syndrome due to the sympathetic disruption at any point along the pathway from the posterolateral hypothalamus to the cervical sympathetic trunk. 1 It is awell-recognized but infrequententity following cervical spine instrumentation through the anterior approach with an incidence ranging from 0.02% to 3.8% during the anterior cervical discectomy and fusion (ACDF) proce-dure. 2,3 We report a rare case of transient Horner ’ ssyndrome following posterior cervical spine instrumentation for congenital atlantoaxial dislocation (AAD). A 13-year-old male patient presented with neck pain and weakness in all four limbs for the past 6 months. Neurologi-cal examination revealed a motor power of grade 3 in all four limbs with a normal pupillary size and reactivity. A diagnosis of reducible AAD was considered based on the dynamic computed tomographic (CT) imaging without radiological evidence of basilar invagination or Arnold Chiari malforma-tion. The patient was planned for C1-C2 fusion under general anesthesia in the prone position. After induction of anesthesia, the patient was placed in the prone position, the head was fi xed with the May fi eld clamp, and the eyes were
{"title":"Transient Horner's Syndrome following Posterior Cervical Spine Instrumentation: A Postoperative Dilemma","authors":"Balaji Vaithialingam, Mouleeswaran Sundaram, V. Bhadrinarayan","doi":"10.1055/s-0042-1757170","DOIUrl":"https://doi.org/10.1055/s-0042-1757170","url":null,"abstract":"Horner ’ s syndrome is a rare phenomenon associated with a wide variety of medical and surgical conditions. Ipsilateral ptosis and miosis occur in Horner ’ s syndrome due to the sympathetic disruption at any point along the pathway from the posterolateral hypothalamus to the cervical sympathetic trunk. 1 It is awell-recognized but infrequententity following cervical spine instrumentation through the anterior approach with an incidence ranging from 0.02% to 3.8% during the anterior cervical discectomy and fusion (ACDF) proce-dure. 2,3 We report a rare case of transient Horner ’ ssyndrome following posterior cervical spine instrumentation for congenital atlantoaxial dislocation (AAD). A 13-year-old male patient presented with neck pain and weakness in all four limbs for the past 6 months. Neurologi-cal examination revealed a motor power of grade 3 in all four limbs with a normal pupillary size and reactivity. A diagnosis of reducible AAD was considered based on the dynamic computed tomographic (CT) imaging without radiological evidence of basilar invagination or Arnold Chiari malforma-tion. The patient was planned for C1-C2 fusion under general anesthesia in the prone position. After induction of anesthesia, the patient was placed in the prone position, the head was fi xed with the May fi eld clamp, and the eyes were","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45067131","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}
Mukilan Balasubramanian, Ankita Dey, Rajasekar Ramadurai, A. Kuberan
Microscope-integrated indocyanine green video angiography (ICG-VA) is used to assess the completeness of clipping and cerebral vascular fl ow during aneurysm surgery. 1 It is a more practical and less time-consuming alternative to intraoperative digital subtraction angiography (DSA). ICG has been reported to cause a decrease in peripheral oxygen saturation (SpO 2 ). 2 – 4 We report a 48-year-old male who presented with complaints of holocranial throbbing headache for 1 month without any history of seizures or focal neurological de fi cit. The patient was a known alcoholic for the past 20 years. Liver function test showed hyperbilirubinemia and elevat-ed serum transaminases. Noncontrast computed tomogra-phy brain revealed subarachnoid hemorrhage. The patient was found to have two aneurysms in the anterior cerebral circulation, one in the anterior communicating artery and one in the right M1 middle cerebral artery, on a DSA scan. He was scheduled for a craniotomy and clipping of both aneurysms. ICG (Aurogreen, Aurolab, Madurai, Tamil Nadu, India) at a dose of 0.25mg/kg
{"title":"Indocyanine Green Administration May Cause an Exaggerated Peripheral Oxygen Desaturation in the Presence of Liver Disease—An Underemphasized Observation","authors":"Mukilan Balasubramanian, Ankita Dey, Rajasekar Ramadurai, A. Kuberan","doi":"10.1055/s-0042-1760270","DOIUrl":"https://doi.org/10.1055/s-0042-1760270","url":null,"abstract":"Microscope-integrated indocyanine green video angiography (ICG-VA) is used to assess the completeness of clipping and cerebral vascular fl ow during aneurysm surgery. 1 It is a more practical and less time-consuming alternative to intraoperative digital subtraction angiography (DSA). ICG has been reported to cause a decrease in peripheral oxygen saturation (SpO 2 ). 2 – 4 We report a 48-year-old male who presented with complaints of holocranial throbbing headache for 1 month without any history of seizures or focal neurological de fi cit. The patient was a known alcoholic for the past 20 years. Liver function test showed hyperbilirubinemia and elevat-ed serum transaminases. Noncontrast computed tomogra-phy brain revealed subarachnoid hemorrhage. The patient was found to have two aneurysms in the anterior cerebral circulation, one in the anterior communicating artery and one in the right M1 middle cerebral artery, on a DSA scan. He was scheduled for a craniotomy and clipping of both aneurysms. ICG (Aurogreen, Aurolab, Madurai, Tamil Nadu, India) at a dose of 0.25mg/kg","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48460501","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. Puri, Shalvi Mahajan, K. Jangra, Rajeev Chauhan, Sanjay Kumar, A. Aggarwal, S. Vyas, H. Bhagat
Abstract Background The pathophysiological changes following aneurysmal subarachnoid hemorrhage (aSAH) lead to a varied degree of neurological deficit and cognitive decline. The presence of comorbidities can contribute to the progression and course of the disease resulting in high morbidity and mortality. Methods A total of 140 patients with aSAH, scheduled for surgical clipping or endovascular coiling were included. The patients' comorbidities were recorded. The postoperative outcome was evaluated using Glasgow Outcome Scale at 1 month following discharge. Multiple logistic regression analysis was performed to identify variables predicting poor outcome, taking into consideration those variables which were significant in univariate analysis. Results Sixty-six percent of these patients with aSAH had associated comorbidities. In our patient cohort, we found that smoking and hypertension were associated with worse outcome (odds ratio [OR] = 4.63 [confidence interval [CI] = 1.83–11.7] and OR = 2.92 [CI = 1.41–6.01], respectively). Hypothyroidism, diabetes mellitus, coronary artery disease, and asthma did not influence the neurological outcome because of their small number. Conclusion Presence of comorbidities like smoking and hypertension significantly worsen the outcome of these patients with aSAH.
{"title":"Effect of Comorbidities on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study","authors":"S. Puri, Shalvi Mahajan, K. Jangra, Rajeev Chauhan, Sanjay Kumar, A. Aggarwal, S. Vyas, H. Bhagat","doi":"10.1055/s-0042-1756431","DOIUrl":"https://doi.org/10.1055/s-0042-1756431","url":null,"abstract":"Abstract Background The pathophysiological changes following aneurysmal subarachnoid hemorrhage (aSAH) lead to a varied degree of neurological deficit and cognitive decline. The presence of comorbidities can contribute to the progression and course of the disease resulting in high morbidity and mortality. Methods A total of 140 patients with aSAH, scheduled for surgical clipping or endovascular coiling were included. The patients' comorbidities were recorded. The postoperative outcome was evaluated using Glasgow Outcome Scale at 1 month following discharge. Multiple logistic regression analysis was performed to identify variables predicting poor outcome, taking into consideration those variables which were significant in univariate analysis. Results Sixty-six percent of these patients with aSAH had associated comorbidities. In our patient cohort, we found that smoking and hypertension were associated with worse outcome (odds ratio [OR] = 4.63 [confidence interval [CI] = 1.83–11.7] and OR = 2.92 [CI = 1.41–6.01], respectively). Hypothyroidism, diabetes mellitus, coronary artery disease, and asthma did not influence the neurological outcome because of their small number. Conclusion Presence of comorbidities like smoking and hypertension significantly worsen the outcome of these patients with aSAH.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46124322","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}
Pragnitha Chitteti, Ajish Sam George, Shalini Nair, Reka Karuppasamy, M. Joseph
Abstract Background An important factor affecting the outcome of traumatic brain injury (TBI) is the early management of raised intracranial pressure (ICP). Head-of-bed elevation (HBE) is a simple and effective method to reduce ICP and prevent aspiration in head injury. Methods This audit was carried out in a level one trauma center. All adult TBI patients were included in the study except patients who had relative contraindication to HBE, managed in prone or Trendelenburg position or who were able to be seated themselves. Patients were observed twice daily, to check adherence to HBE. Adequate HBE angle was referred as an angle of 20 to 30 degrees. A digital protractor was used to measure the head-end angle. Following the first audit cycle, after discussion with nursing staff, a bedside checklist was formulated and two postintervention audit cycles were carried out. Results The first cycle showed that 40.35% of patients had inadequate HBE. Following implementation of the checklist, this percentage dropped to 11.27 and 7.5% in the second and third cycles, respectively. Agitation ( p -value = 0.038) and Glasgow coma scale at admission ( p -value = 0.028) were found to be confounders for adherence to HBE. Conclusion Agitation among mild and moderate TBI patients contributed to noncompliance for HBE. There was an increasing trend in adherence to maintaining adequate HBE following the use of a bedside checklist. Sustainability of improvement was confirmed with third audit cycle.
{"title":"Adherence to Head-of-Bed Elevation in Traumatic Brain Injury: An Audit","authors":"Pragnitha Chitteti, Ajish Sam George, Shalini Nair, Reka Karuppasamy, M. Joseph","doi":"10.1055/s-0042-1758749","DOIUrl":"https://doi.org/10.1055/s-0042-1758749","url":null,"abstract":"Abstract Background An important factor affecting the outcome of traumatic brain injury (TBI) is the early management of raised intracranial pressure (ICP). Head-of-bed elevation (HBE) is a simple and effective method to reduce ICP and prevent aspiration in head injury. Methods This audit was carried out in a level one trauma center. All adult TBI patients were included in the study except patients who had relative contraindication to HBE, managed in prone or Trendelenburg position or who were able to be seated themselves. Patients were observed twice daily, to check adherence to HBE. Adequate HBE angle was referred as an angle of 20 to 30 degrees. A digital protractor was used to measure the head-end angle. Following the first audit cycle, after discussion with nursing staff, a bedside checklist was formulated and two postintervention audit cycles were carried out. Results The first cycle showed that 40.35% of patients had inadequate HBE. Following implementation of the checklist, this percentage dropped to 11.27 and 7.5% in the second and third cycles, respectively. Agitation ( p -value = 0.038) and Glasgow coma scale at admission ( p -value = 0.028) were found to be confounders for adherence to HBE. Conclusion Agitation among mild and moderate TBI patients contributed to noncompliance for HBE. There was an increasing trend in adherence to maintaining adequate HBE following the use of a bedside checklist. Sustainability of improvement was confirmed with third audit cycle.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48490072","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}
Trigeminocardiac re fl ex (TCR) from stimulation of sensory branches of trigeminal nerve during neurosurgeries may produce various types of arrhythmias, including bradycar-dia and asystole. Rarely, TCR can present with unusual manifestations such as tachyarrhythmias secondary to sympathetic stimulation. Ventricular tachycardia (VT) and fi - brillation (VF) are rare in neurosurgical patients without preexisting cardiac etiology. We report such presentation during simultaneous surgery of cerebral aneurysmal clipping and trigeminal schwannoma excision that was man-aged successfully. A 52-year-old female patient with a history of hypertension presented with headache and one episode of loss of consciousness. Her admission Glasgow Coma Scale score was E4V5M6. On radiological evaluation, she was diagnosed with subarachnoid hemorrhage (aneurysmal) from ruptured anterior communicating artery aneurysm measuring 1.1 (cid:1) 0.8cm and coexisting trigeminal schwannoma measuring 4.3 (cid:1) 4.1cm ( ► Fig.
{"title":"Ventricular Fibrillation as an Uncommon Manifestation of Trigeminocardiac Reflex during Simultaneous Surgery for Aneurysmal Clipping and Trigeminal Schwannoma Resection","authors":"K. Pallavi, A. Goyal, S. Kamath","doi":"10.1055/s-0042-1757155","DOIUrl":"https://doi.org/10.1055/s-0042-1757155","url":null,"abstract":"Trigeminocardiac re fl ex (TCR) from stimulation of sensory branches of trigeminal nerve during neurosurgeries may produce various types of arrhythmias, including bradycar-dia and asystole. Rarely, TCR can present with unusual manifestations such as tachyarrhythmias secondary to sympathetic stimulation. Ventricular tachycardia (VT) and fi - brillation (VF) are rare in neurosurgical patients without preexisting cardiac etiology. We report such presentation during simultaneous surgery of cerebral aneurysmal clipping and trigeminal schwannoma excision that was man-aged successfully. A 52-year-old female patient with a history of hypertension presented with headache and one episode of loss of consciousness. Her admission Glasgow Coma Scale score was E4V5M6. On radiological evaluation, she was diagnosed with subarachnoid hemorrhage (aneurysmal) from ruptured anterior communicating artery aneurysm measuring 1.1 (cid:1) 0.8cm and coexisting trigeminal schwannoma measuring 4.3 (cid:1) 4.1cm ( ► Fig.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47602643","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}
Shamik K. Paul, Shalendra Singh, V. Krishna, Gunjan Singh
A negative-suction pressure subgaleal drain is most com-monly applied during the closure of the cranial defect to reduce the risk of postoperative hematoma formation. The literature revealed few cases of life-threatening subgaleal negative pressure drain (SNPD) associated complications. 1 We report a probable case of reverse brain herniation (RBH) or trigeminocardiac re fl ex (TCR) from application of SNDP following craniotomy. Both RBH and TCR are the least understood complications of SNDP. TCR is an autonomic brainstem re fl ex that manifests as sudden bradycardia, hypotension, and gastric hypermotility. This re fl ex occurs when there is a stimulation of the trigeminal nerve or any of its branches. Though, believed to be an inherent protective re fl ex, it can lead to adverse outcome if exaggerated. 2 Whereas RBH has been reported following cerebrospinal fl uid (CSF) diversion procedure or removal of CSF during posterior fossa surgery, 3 but has also been seen following SNDP in supratentorial surgery. 1 RBH is the least understood of brain herniation syndromes and is a rare complication of ventriculoperitoneal shunt 4 and also after SNDP placement. 5 The early identi fi cation of RBH and TCR during scalp closure is imperative to prevent a precipitous drop in heart rate, blood pressure, and further circulatory arrest. Knowledge of both these
{"title":"Collapse Following Subgaleal Negative Pressure Drain Application: Reverse Brain Herniation or Trigeminocardiac Reflex?","authors":"Shamik K. Paul, Shalendra Singh, V. Krishna, Gunjan Singh","doi":"10.1055/s-0042-1756434","DOIUrl":"https://doi.org/10.1055/s-0042-1756434","url":null,"abstract":"A negative-suction pressure subgaleal drain is most com-monly applied during the closure of the cranial defect to reduce the risk of postoperative hematoma formation. The literature revealed few cases of life-threatening subgaleal negative pressure drain (SNPD) associated complications. 1 We report a probable case of reverse brain herniation (RBH) or trigeminocardiac re fl ex (TCR) from application of SNDP following craniotomy. Both RBH and TCR are the least understood complications of SNDP. TCR is an autonomic brainstem re fl ex that manifests as sudden bradycardia, hypotension, and gastric hypermotility. This re fl ex occurs when there is a stimulation of the trigeminal nerve or any of its branches. Though, believed to be an inherent protective re fl ex, it can lead to adverse outcome if exaggerated. 2 Whereas RBH has been reported following cerebrospinal fl uid (CSF) diversion procedure or removal of CSF during posterior fossa surgery, 3 but has also been seen following SNDP in supratentorial surgery. 1 RBH is the least understood of brain herniation syndromes and is a rare complication of ventriculoperitoneal shunt 4 and also after SNDP placement. 5 The early identi fi cation of RBH and TCR during scalp closure is imperative to prevent a precipitous drop in heart rate, blood pressure, and further circulatory arrest. Knowledge of both these","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49151628","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}
Aparna Depuru, N. Bhatia, H. Bhagat, Apinderpreet Singh
Abstract Cranioplasty is a surgical procedure that restores the normal anatomy following craniectomy. Restoring the skull bone ensures protection and normalizes the physiology as well as the cerebrospinal fluid dynamics. This surgical procedure usually requires administration of general anesthesia for retrieving the bone placed in the abdominal region and thereafter placing it in the cranium. We report the anesthetic management of a high-risk case who had severe mitral stenosis and was scheduled for cranioplasty. The anesthetic management of a patient with rheumatic heart disease, with severe mitral stenosis, posted for cranioplasty, is extremely challenging. The presence of cardiac pathology necessitates the need to balance patient's hemodynamics in accordance with the cardiac grid and tests the limits of the anesthesiologist's preparedness. We describe our experience of conduct of this case in regional anesthesia using scalp block on the defect site with an oblique transverse abdominis plane block for abdominal bone retrieval.
{"title":"Awake Cranioplasty in a Patient with Rheumatic Heart Disease: A Novel Approach","authors":"Aparna Depuru, N. Bhatia, H. Bhagat, Apinderpreet Singh","doi":"10.1055/s-0042-1756429","DOIUrl":"https://doi.org/10.1055/s-0042-1756429","url":null,"abstract":"Abstract Cranioplasty is a surgical procedure that restores the normal anatomy following craniectomy. Restoring the skull bone ensures protection and normalizes the physiology as well as the cerebrospinal fluid dynamics. This surgical procedure usually requires administration of general anesthesia for retrieving the bone placed in the abdominal region and thereafter placing it in the cranium. We report the anesthetic management of a high-risk case who had severe mitral stenosis and was scheduled for cranioplasty. The anesthetic management of a patient with rheumatic heart disease, with severe mitral stenosis, posted for cranioplasty, is extremely challenging. The presence of cardiac pathology necessitates the need to balance patient's hemodynamics in accordance with the cardiac grid and tests the limits of the anesthesiologist's preparedness. We describe our experience of conduct of this case in regional anesthesia using scalp block on the defect site with an oblique transverse abdominis plane block for abdominal bone retrieval.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43446963","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}
J. Dubey, Nitesh Goel, R. Chawla, Manish Gupta, M. Bhardwaj
Abstract Background Bi-spectral index (BIS) has been traditionally used to monitor the depth of anesthesia, with the forehead being the usual site for electrode placement. When the manufacturer-recommended site is itself an operative field or the placement interferes with the surgery, the search for an alternative position of electrode placement is warranted. In our endeavor to do so, we conducted this study to compare BIS scores derived from frontal and supralabial electrode placement. Methods A cross-sectional study was conducted on a group of 50 patients using two BIS Quatro sensors attached to the frontal and supralabial regions of each patient and connected to two different sets of monitors. BIS values, electromyography (EMG) values, and signal quality index (SQI) were noted from both sites every 15 min during the maintenance phase of anesthesia. Collected data were analyzed using the Bland–Altman analysis. Results Data analysis of BIS values showed negative bias at most time points with a minimum negative bias of 0.2 with a limit of agreement of −3.67/3.27 and a maximum negative bias of 1.14 with a limit of agreement of −7.61/5.33. The overall 95% limit of agreement for pooled BIS data ranged from −6.63 to 6.1. Conclusion BIS sensor placement at the supralabial site can be used as an alternative to the frontal placement in scenarios where the frontal position is the surgical site or is inaccessible during the maintenance of general anesthesia as in neurosurgery with particular emphasis on skin preparation and proper positioning of BIS electrodes to improve the signal quality.
{"title":"Supralabial Site: An Alternative Site for Bispectral Index Monitoring: A Cross-sectional Study","authors":"J. Dubey, Nitesh Goel, R. Chawla, Manish Gupta, M. Bhardwaj","doi":"10.1055/s-0042-1756430","DOIUrl":"https://doi.org/10.1055/s-0042-1756430","url":null,"abstract":"Abstract Background Bi-spectral index (BIS) has been traditionally used to monitor the depth of anesthesia, with the forehead being the usual site for electrode placement. When the manufacturer-recommended site is itself an operative field or the placement interferes with the surgery, the search for an alternative position of electrode placement is warranted. In our endeavor to do so, we conducted this study to compare BIS scores derived from frontal and supralabial electrode placement. Methods A cross-sectional study was conducted on a group of 50 patients using two BIS Quatro sensors attached to the frontal and supralabial regions of each patient and connected to two different sets of monitors. BIS values, electromyography (EMG) values, and signal quality index (SQI) were noted from both sites every 15 min during the maintenance phase of anesthesia. Collected data were analyzed using the Bland–Altman analysis. Results Data analysis of BIS values showed negative bias at most time points with a minimum negative bias of 0.2 with a limit of agreement of −3.67/3.27 and a maximum negative bias of 1.14 with a limit of agreement of −7.61/5.33. The overall 95% limit of agreement for pooled BIS data ranged from −6.63 to 6.1. Conclusion BIS sensor placement at the supralabial site can be used as an alternative to the frontal placement in scenarios where the frontal position is the surgical site or is inaccessible during the maintenance of general anesthesia as in neurosurgery with particular emphasis on skin preparation and proper positioning of BIS electrodes to improve the signal quality.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45586653","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}
Challenges faced by healthcare professionals in their personal and professional life are aplenty. Facing them effectively requires following the footsteps of and learning from the experiences of role models, seniors, and colleagues, alike. A successful healthcare professional is one who is most likely mentored for such challenges through the various phases of his/her educational path and even further. Various definitions exist for the term “mentor.” Simply put, a mentor is a supporting person providing two broad categories of service to another individual (the mentee): (1) career enhancement and (2) psychosocial support. Career enhancement provides the mentee to perform challenging assignments, adequate exposure in the respective fields, and ensures that professional ethical values are imbibed. Psychosocial support, possibly the more important aspect of mentorship, prepares the mentee to perform the tasks of career enhancement by ensuring that the mentor provides a role model, counselor, and friend. This aspect of mentorship enhances the mentee’s workethic and productivity.1
{"title":"Mentorship in Neuroanesthesia and Neurocritical Care","authors":"Jayanth R Seshan, G. Rath","doi":"10.1055/s-0043-1761219","DOIUrl":"https://doi.org/10.1055/s-0043-1761219","url":null,"abstract":"Challenges faced by healthcare professionals in their personal and professional life are aplenty. Facing them effectively requires following the footsteps of and learning from the experiences of role models, seniors, and colleagues, alike. A successful healthcare professional is one who is most likely mentored for such challenges through the various phases of his/her educational path and even further. Various definitions exist for the term “mentor.” Simply put, a mentor is a supporting person providing two broad categories of service to another individual (the mentee): (1) career enhancement and (2) psychosocial support. Career enhancement provides the mentee to perform challenging assignments, adequate exposure in the respective fields, and ensures that professional ethical values are imbibed. Psychosocial support, possibly the more important aspect of mentorship, prepares the mentee to perform the tasks of career enhancement by ensuring that the mentor provides a role model, counselor, and friend. This aspect of mentorship enhances the mentee’s workethic and productivity.1","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42216137","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}
R. Mishra, K. Sriganesh, Rohini M. Surve, R. Sangeetha, D. Chakrabarti, Abhinith Shashidhar, Janaki L Anju
Background Patients with coronavirus disease 2019 (COVID-19) presenting for neurosurgery are not rare. Considering the lack of literature informing the outcomes in this subset, present study was conducted to compare perioperative management and postoperative outcomes between COVID-19 and non-COVID-19 neurosurgical patients. Methods After ethics committee approval, data of all patients with COVID-19 along with an equal number of age and diagnosis matched non-COVID-19 patients undergoing neurosurgery between April 2020 and January 2021 was analyzed retrospectively. Predictors of poor outcome were identified using multivariate logistic regression analysis. Results During the study period, 50 COVID-19 patients (28 laboratory confirmed (group-C) and 22 clinicoradiological diagnosed [group-CR]) underwent neurosurgery and were compared with 50 matched non-COVID-19 patients. Preoperatively, clinicoradiological diagnosed COVID-19 patients had higher American Society of Anesthesiologists (ASA) grade (p = 0.01), lower Glasgow Coma Scale (GCS) score (p < 0.001), and more pulmonary involvement (p = 0.004). The duration of intensive care unit stay was significantly longer in laboratory confirmed patients (p = 0.03). Poor clinical outcome (in-hospital mortality or discharge motor-GCS ≤ 5) did not differ significantly between the groups (p = 0.28). On univariate analysis, younger age, higher ASA grade, lower preoperative GCS, and motor-GCS, higher intraoperative blood and fluid administration and traumatic brain injury diagnosis were associated with poor outcome. On multivariable logistic regression. only lower preoperative motor-GCS remained the predictor of poor outcome. Conclusions The concomitant presence of COVID-19 infection did not translate into poor outcome in patients undergoing neurosurgery. Preoperative motor-GCS predicted neurological outcome in both COVID-19 and non-COVID-19 neurosurgical patients.
{"title":"Comparison of Perioperative Characteristics and Clinical Outcomes of COVID-19 and non-COVID-19 Patients Undergoing Neurosurgery—A Retrospective Analysis","authors":"R. Mishra, K. Sriganesh, Rohini M. Surve, R. Sangeetha, D. Chakrabarti, Abhinith Shashidhar, Janaki L Anju","doi":"10.1055/s-0042-1749144","DOIUrl":"https://doi.org/10.1055/s-0042-1749144","url":null,"abstract":"Background Patients with coronavirus disease 2019 (COVID-19) presenting for neurosurgery are not rare. Considering the lack of literature informing the outcomes in this subset, present study was conducted to compare perioperative management and postoperative outcomes between COVID-19 and non-COVID-19 neurosurgical patients. Methods After ethics committee approval, data of all patients with COVID-19 along with an equal number of age and diagnosis matched non-COVID-19 patients undergoing neurosurgery between April 2020 and January 2021 was analyzed retrospectively. Predictors of poor outcome were identified using multivariate logistic regression analysis. Results During the study period, 50 COVID-19 patients (28 laboratory confirmed (group-C) and 22 clinicoradiological diagnosed [group-CR]) underwent neurosurgery and were compared with 50 matched non-COVID-19 patients. Preoperatively, clinicoradiological diagnosed COVID-19 patients had higher American Society of Anesthesiologists (ASA) grade (p = 0.01), lower Glasgow Coma Scale (GCS) score (p < 0.001), and more pulmonary involvement (p = 0.004). The duration of intensive care unit stay was significantly longer in laboratory confirmed patients (p = 0.03). Poor clinical outcome (in-hospital mortality or discharge motor-GCS ≤ 5) did not differ significantly between the groups (p = 0.28). On univariate analysis, younger age, higher ASA grade, lower preoperative GCS, and motor-GCS, higher intraoperative blood and fluid administration and traumatic brain injury diagnosis were associated with poor outcome. On multivariable logistic regression. only lower preoperative motor-GCS remained the predictor of poor outcome. Conclusions The concomitant presence of COVID-19 infection did not translate into poor outcome in patients undergoing neurosurgery. Preoperative motor-GCS predicted neurological outcome in both COVID-19 and non-COVID-19 neurosurgical patients.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41253476","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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