Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2022
Perioperative Risk Factors Associated With Acute Kidney Injury in Patients After Brain Tumor Resection.
Acute kidney injury (AKI) is a serious complication after surgery. The aim of this study is to identify risk factors for postoperative AKI in patients undergoing brain tumor surgery. ⋯ Multiple factors, including preoperative administration of mannitol, are independently associated with the development of postoperative AKI in patients undergoing brain tumor surgery.
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J Neurosurg Anesthesiol · Jan 2022
ReviewA Tale of Two Supercities: Early COVID-19 Outcomes Reflect Social Vulnerability in New York City and San Francisco.
In this narrative review, anesthesiologists at 2 large hospital systems in New York City and San Francisco compare early coronavirus disease 2019 (COVID-19) public health outcomes while considering the role played by social vulnerability and relevant approaches in their 2 cities. An iterative search process allowed for a broad review of medical and public policy research, as well as newspaper reports, expert opinion, and multimedia sources, with the goal of exploring the importance of crowding, the labor force, and social identity in pandemic experiences. Related struggles, pitfalls, and successful interventions in both locales are summarized. Although technology in the form of vaccination will likely play an outsize role in the next phase of the pandemic, our review concludes that we must carefully consider how social vulnerabilities have and will continue to inform equitable and effective access to life-saving resources.
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The coronavirus disease 2019 (COVID-19) pandemic incited a global clinical trial research agenda of unprecedented speed and high volume. This expedited research activity in a time of crisis produced both successes and failures that offer valuable learning opportunities for the scientific community to consider. Successes include the implementation of large adaptive and pragmatic trials as well as burgeoning efforts toward rapid data synthesis and open science principles. ⋯ Other challenges that became highlighted were the need to find unbiased designs for investigating complex, nonpharmaceutical interventions and the use of routinely collected data for outcomes assessment. This article discusses these issues juxtaposing the COVID-19 trials experience against trials in anesthesiology and other fields. These lessons may serve as a positive catalyst for transforming future clinical trial research.
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J Neurosurg Anesthesiol · Jan 2022
Reappearance of Neurological Deficits in Pathologic Brain: Are Sedatives and Opioids Culprits? A Systematic Review.
Following a brain insult, focal neurological deficits may develop. Despite resolution of these deficits with time, the subsequent administration of sedative medications and opioids may lead to recrudescence of previous neurological deficits. Therefore, the present systematic review aims to explore the role of different sedatives and opioid analgesics at reproducing focal neurological deficits in patients with previous brain insults undergoing surgery. ⋯ In contrast, it is not clear based on our study whether the unmasking or worsening of neurological deficits occurs following recent injuries or an older brain insult, although for most patients it appears to be the former. Future studies are needed to elucidate the mechanisms involved in unmasking prior deficits and/or extension of prior injuries by sedative and opioid analgesics. This review will aid in developing prospective studies on individual sedative medications and their effects on unmasking neurological deficits in patients with multiple brain pathologies.
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Columbia University's Papper Symposium, a virtual event held on March 20, 2021, was dedicated to the coronavirus disease-2019 (COVID-19) pandemic. This article summarizes a lecture by Dr. Roberta Hines, Nicholas M. ⋯ Trainees working on the frontlines may be at particularly high risk for these mental health disorders and are less likely to access resources available to them. Program directors and hospital graduate medical education leaders should be aware of the threats to physiological and psychological safety and take action to prevent further detrimental effects. The rates of burnout and mental health disorders among trainees are expected to rise as a result of the pandemic, making screening programs and increased access to mental health treatment an essential feature of all residency and fellowship programs.