Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2021
ReviewEffect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery: A Narrative Review.
Deep brain stimulation (DBS) is an effective surgical treatment for patients with various neurological and psychiatric disorders. Clinical improvements rely on careful patient selection and accurate electrode placement. A common method for target localization is intraoperative microelectrode recording (MER). ⋯ However, sedation or general anesthesia is sometimes needed for patients who are unable to tolerate the procedure fully awake because of severe motor symptoms, psychological distress, pain, or other forms of discomfort. The effect of anesthetic drugs on MER is controversial but likely depends on the type and dose of a particular anesthetic agent, underlying disease, and surgical target. In this narrative review, we provide an overview of the current literature on the anesthetic drugs most often used for sedation and anesthesia during DBS surgery, with a focus on their effects on MERs.
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J Neurosurg Anesthesiol · Oct 2021
Extracellular Glutamate Concentration Increases Linearly in Proportion to Decreases in Residual Cerebral Blood Flow After the Loss of Membrane Potential in a Rat Model of Ischemia.
Brain ischemia due to disruption of cerebral blood flow (CBF) results in increases in extracellular glutamate concentration and neuronal cell damage. However, the impact of CBF on glutamate dynamics after the loss of the membrane potential remains unknown. ⋯ Our results indicate that residual CBF is an important factor that determines the extracellular glutamate concentration after the loss of membrane potential, and residual CBF would be one of the important determinants of neuronal cell prognosis.
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J Neurosurg Anesthesiol · Oct 2021
Meta AnalysisHemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.
Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. ⋯ The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=-169 mL; 95% CI=-1463 to 1126 mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring-guided management on aSAH outcomes.