Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2023
Ethical Management of COVID-19 Pandemic at a Neurological Hospital: The Ethicovid report.
During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of COVID-19 patients. ⋯ Our ethical consulting unit allowed for collegial ethical decision-making in line with international recommendations. This model could be easily transferred to other triage situations, provided it is adapted to the local context.
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J Neurosurg Anesthesiol · Oct 2023
Early Neurodevelopmental Outcomes Following Exposure to General Anesthesia in Infancy: EGAIN, a Prospective Cohort Study.
General anesthesia (GA) is known to worsen neural outcomes in animals, but human research assessing early-life GA exposure and neurodevelopment show inconsistent findings. We investigated the effects of a single GA exposure for minor surgery on the neurodevelopment of healthy children at multiple time-points, using clinical assessments along with behavioral and neurophysiological measures rarely used in human research. ⋯ GA-exposed children did not differ from unexposed children in cognitive, language or motor outcomes at 24 months, but exhibited poorer parent-reported behavior scores. Differences in infant behavior and neurophysiology were detected at 6 and 18 months. Neurophysiological assessments may complement clinically relevant assessments to provide greater insights into neurodevelopment following early GA exposure.
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J Neurosurg Anesthesiol · Oct 2023
ReviewCerebral Autoregulation-guided Management of Adult and Pediatric Traumatic Brain Injury.
Cerebral autoregulation (CA) plays a vital role in maintaining cerebral blood flow in response to changes in systemic blood pressure. Impairment of CA following traumatic brain injury (TBI) may exacerbate the injury, potentially impacting patient outcomes. ⋯ We examine the feasibility and safety of CA assessment, its association with clinical outcomes, and the potential for reversing deranged CA following TBI. Finally, we discuss how the knowledge of CA status may affect TBI management and outcomes.