Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2012
Randomized Controlled TrialThe effects of P6 electrical acustimulation on postoperative nausea and vomiting in patients after infratentorial craniotomy.
Postoperative nausea and vomiting (PONV) are frequent and harmful complications after neurosurgery. Current pharmacy-based treatment is the standard of care; it, however, lacks efficiency. Invasive and noninvasive acupuncture at the P6 meridian point has been shown to be effective in the prevention of PONV. We evaluated the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) at P6 for the prophylaxis of PONV in patients undergoing infratentorial craniotomy. ⋯ Perioperative TEAS at P6 may be an effective adjunct to the standard antiemetic drug therapy for the prevention of PONV after infratentorial craniotomy.
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J Neurosurg Anesthesiol · Oct 2012
ReviewElective procedures and anesthesia in children: pediatric surgeons enter the dialogue on neurotoxicity questions, surgical options, and parental concerns.
The Pediatric Anesthesia NeuroDevelopment Assessment research group at Columbia University Medical Center Department of Anesthesiology has conducted biannual national Symposia since 2008 to evaluate study data and invigorate continued thinking about unresolved issues of pediatric anesthesia neurotoxicities. The third Symposium extended the dialogue between pediatric anesthesiologists and surgeons in panel presentations and discussions by four surgical specialists. This paper reports the prevailing opinions expressed by a pediatric general surgeon, urologist, plastic surgeon and ophthalmologist and explores factors related to delayed operative intervention, need for multiple procedures, and parental concerns.
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J Neurosurg Anesthesiol · Oct 2012
Review Meta AnalysisPediatric anesthesia and neurodevelopmental impairments: a Bayesian meta-analysis.
Experimental evidence of anesthesia-induced neurotoxicity has caused serious concern about the long-term effect of commonly used volatile anesthetic agents on young children. Several observational studies based on existing data have been conducted to address this concern with inconsistent results. We conducted a meta-analysis to synthesize the epidemiologic evidence on the association of anesthesia/surgery with neurodevelopmental outcomes in children. ⋯ The most likely adjusted OR from a future study was estimated to be 1.5 (95% CrI, 0.5-4.0). We conclude that existent epidemiologic evidence suggests a modestly elevated risk of adverse behavioral or developmental outcomes in children who were exposed to anesthesia/surgery during early childhood. The evidence, however, is considerably uncertain.
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J Neurosurg Anesthesiol · Oct 2012
Review Historical ArticleSnapshot of 1973 and 1974: critical thinkers and contemporary research ideas in neurosurgical anesthesia during the first years of SNACC.
The year 2012 marks the 40th anniversary of the Society of Neuroscience in Anesthesiology and Critical Care (SNACC). To celebrate this occasion, we provide a review, speculative synthesis, and commentary addressing research relevant to neurosurgical anesthesiology in 1973 and 1974--the early years of SNACC. We address topics such as effects of anesthetic drugs, neuroprotection, cerebral physiology, and monitoring as they relate to the perioperative care of neurosurgical patients or patients experiencing or at risk for neurological disorders. Our hypothesis is that a review of these publications will identify the foundations of research and practice concepts that persist until today and will also identify concepts that have dwindled or outright disappeared.
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J Neurosurg Anesthesiol · Oct 2012
Feasibility and pilot study of the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project.
Animal studies have documented that exposure of the developing brain to commonly used anesthetic agents induces neurotoxicity and late abnormal neurobehavioral functions as adults. Results from clinical studies have all been analyzed using existing data sets, and these studies produced inconsistent results. To provide more definitive evidence to address the clinical relevance of anesthetic neurotoxicity in children, an interdisciplinary team of investigators designed and developed the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project. We present pilot study results in 28 sibling pairs recruited and tested at the Columbia University Medical Center (CUMC) and Children's Hospital of Boston (CHB) for the PANDA project. ⋯ The pilot study provided useful information for feasibility to recruit the sample size and to obtain relevant clinical data. For the final study protocol, both the neuropsychological battery and the age range for testing were revised. Our results confirmed the feasibility of our study approach and yielded pilot data from neuropsychological testing.