Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2022
Randomized Controlled TrialSafety of Nitrous Oxide Anesthesia in a Selected Group of Patients Undergoing Neurosurgery: An Exploratory Subgroup Analysis of the ENIGMA Trials.
The Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia (ENIGMA)-I and ENIGMA-II were randomized clinical trials that assessed the safety of nitrous oxide anesthesia in patients undergoing noncardiac surgery. In this study, we performed an exploratory pooled analysis of both ENIGMA trials to assess the safety of nitrous oxide in a selected group of patients undergoing neurosurgery. ⋯ Nitrous oxide did not increase the risk of postoperative complications or prolonged length of hospital stay in the neurosurgical cohort enrolled in the ENIGMA-I and ENIGMA-II trials.
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J Neurosurg Anesthesiol · Jul 2022
Inadvertent Burst Suppression During Total Intravenous Anesthesia in 112 Consecutive Patients Undergoing Spinal Instrumentation Surgery: A Retrospective Observational Quality Improvement Project.
The incidence and quantification of inadvertent electroencephalographic burst suppression during total intravenous anesthesia (TIVA) for spine instrumentation surgery has not previously been reported. ⋯ High rates and prolonged periods of inadvertent burst suppression may be prevalent during spine instrumentation surgery with TIVA. Our findings suggest that usage of electroencephalography alone is incomplete without prompt interpretation and intervention, mandating close communication between neuromonitoring and anesthesia teams. The dose-response relationship between burst suppression, total time spent in maximal burst suppression, and their association with delirium warrants further evaluation.
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J Neurosurg Anesthesiol · Jul 2022
Brain and Heart Crosstalk During Neurointerventional Procedures: The Role of the Trigeminocardiac Reflex: An Updated Systematic Review.
The trigeminocardiac reflex is a well-described brainstem reflex that clinically manifests as bradycardia, hypotension, or apnea. This physiological phenomenon is extensively reported during open neurosurgical procedures, but very few data exist for trigeminocardiac reflex occurrence during neurointerventional procedures. This systematic review aims to provide aggregated information related to the trigeminocardiac reflex during neurointerventional procedures and to improve understanding of the various mechanisms that can incite this unique brain-heart crosstalk.
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J Neurosurg Anesthesiol · Jul 2022
Postoperative Screening With the Modified National Institutes of Health Stroke Scale After Noncardiac Surgery: A Pilot Study.
Perioperative stroke is associated with high rates of morbidity and mortality, yet there is no validated screening tool. The modified National Institutes of Health Stroke Scale (mNIHSS) is validated for use in nonsurgical strokes but is not well-studied in surgical patients. We evaluated perioperative changes in the mNIHSS score in noncardiac, non-neurological surgery patients, feasibility in the perioperative setting, and the relationship between baseline cognitive screening and change in mNIHSS score. ⋯ Changes in mNIHSS score can occur early after surgery in the absence of overt stroke. Assessment of mNIHSS appears feasible in the perioperative setting, although further research is required to define its role in detecting perioperative stroke.