Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2012
ReviewPreclinical research into the effects of anesthetics on the developing brain: promises and pitfalls.
Every year millions of children are treated with anesthetics and sedatives to alleviate pain and distress during invasive procedures. Accumulating evidence suggests the possibility for deleterious effects on the developing brain. ⋯ Accordingly, this review summarizes the current state of animal research in this field, introduces some of the findings presented at the PANDA symposium, and addresses some of the difficulties in translating these findings to pediatric anesthesia practice, as discussed during the symposium. The symposium participants' consensus was that significant preclinical and clinical research efforts are still needed to investigate this important concern for child health.
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Despite the fact that it has been used since the 1960s in diseases associated with brain edema and has been investigated in >150 publications on head injury, very little has been published on the outcome of osmotherapy. We can only speculate whether osmotherapy improves outcome, has no effect on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. ⋯ These drawbacks, and the fact that the most recent Cochrane meta-analyses of osmotherapy in brain edema and stroke could not find any beneficial effects on outcome, make routine use of osmotherapy in brain edema doubtful. Nevertheless, the use of osmotherapy as a temporary measure may be justified to acutely prevent brain stem compression until other measures, such as evacuation of space-occupying lesions or decompressive craniotomy, can be performed. This article is the Con part in a Pro-Con debate in the present journal on the general routine use of osmotherapy in brain edema.
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J Neurosurg Anesthesiol · Oct 2012
Report of the third PANDA symposium on "Anesthesia and Neurodevelopment in Children".
The Pediatric Anesthesia and NeuroDevelopment Assessment (PANDA) Project team organized its third biennial scientific symposium on "Anesthesia and Neurodevelopment in Children" at the Children's Hospital of New York on April 21, 2012. The event was co-sponsored by the New York-Presbyterian/Morgan Stanley Children's Hospital (MS-CHONY) and the Department of Anesthesiology of Columbia University. The day-long program included updates of recent research in anesthetic neurotoxicity in the developing brain from preclinical studies to clinical and patient-oriented outcome research. It also provided a forum for discussion among many different stakeholders in this important public health issue.
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J Neurosurg Anesthesiol · Oct 2012
Historical ArticleCelebrating Ruby: 40 years of NAS→SNANSC→SNACC→SNACC.
The 40-year history of the Society of Neurosurgical Anesthesia and Critical Care (SNACC) is reviewed. Annual meetings have been a focus for reporting scientific advances and providing education to those attending. ⋯ SNACC has been a strong advocate for educational advances, most recently addressing issues in neuroanesthesia fellowship accreditation and possibly certification. SNACC's initial North American focus has grown such that SNACC is now an international society dedicated to the advancement of neuroanesthesia, neurocritical care, neuromonitoring, and neuroscience.