Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2025
Learnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization.
An anesthesia information management system (AIMS) can be used to assess operating room utilization. The aim of this study was to assess neurosurgery OR utilization patterns using an AIMS. ⋯ AIMS can effectively track and identify operating room utilization patterns by analyzing the durations of various operating room activities. Prospective multicenter studies are required to validate these findings in different surgical populations and centers.
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J Neurosurg Anesthesiol · Jan 2025
Radiographic Predictors of Difficult Fiberscopic Intubation During General Anesthesia in Patients With a Cervical Collar to Simulate a Difficult Airway.
Predictors of difficult fiberscopic intubation have not been fully elucidated. This study focused on identifying radiographic predictors of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar. ⋯ High tongue area/oral cavity area and long skin-glottis distance were predictive of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.
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J Neurosurg Anesthesiol · Jan 2025
Reducing Cerebrospinal Fluid Sampling Frequency and Costs in Patients With Ventriculostomy for Aneurysmal Subarachnoid Hemorrhage: A Quality Improvement Initiative.
We implemented a quality improvement project to transition from routine cerebrospinal fluid (CSF) sampling to indication-based sampling in aneurysmal subarachnoid hemorrhage (aSAH) patients with an external ventricular drain (EVD). ⋯ Transitioning from routine to indication-based CSF sampling in aSAH patients with an EVD reduced sampling frequency and associated costs without increasing infection rates.
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J Neurosurg Anesthesiol · Jan 2025
Meta Analysis Comparative StudyIntensive Versus Standard Blood Pressure Management after Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis.
Prospective clinical studies on blood pressure (BP) management targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) have recently been published. Our objective was to assess the impact on clinical outcomes of BP management guided by established systolic BP (SBP) targets within the first 24 hours after successful EVT. Four randomized controlled trials (RCTs) including 1556 participants across 5 SBP target settings identified from 5 databases up to September 6, 2023 were included in this systematic review and meta-analysis. ⋯ Patients receiving intensive SBP management had lower risk of 90-day functional independence as assessed by the modified Rankin scale score (relative risk [RR], 0.81; 95% confidence interval [CI], 0.72 to 0.91; I2 , 12%), excellent outcomes (RR,0.86; 95% CI, 0.75 to 0.99; I2 , 7%), favorable outcomes (RR, 0.85; 95% CI, 0.78 to 0.92; I2 , 0%), and quality of life (standardized mean difference, -0.22; 95% CI, -0.35 to -0.10; I 2 ,0%). There were no differences in the probability of any intracerebral hemorrhage (RR, 1.04; 95% CI, 0.92 to 1.19; I2 ,0%), symptomatic intracerebral hemorrhage (RR, 1.10; 95% CI, 0.76 to 1.60; I2 , 0%), stroke-related death (RR, 1.16; 95% CI, 0.80 to 1.68; I2 , 0%), or parenchymal hematoma (RR, 1.71; 95% CI, 0.74 to 3.98; I2 , 47%) between SBP targets. This meta-analysis provides evidence from RCTs suggesting that intensive SBP control (target<160 mm Hg) may be detrimental to clinical outcomes in AIS patients with successful reperfusion after EVT.
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J Neurosurg Anesthesiol · Jan 2025
Randomized Controlled Trial Comparative StudyProspective Randomized Controlled Trial Comparing Anesthetic Management With Remimazolam Besylate and Flumazenil Versus Propofol During Awake Craniotomy Following an Asleep-awake-asleep Method.
Awake craniotomy is performed to resect brain tumors in eloquent brain areas to maximize tumor reduction and minimize neurological damage. Evidence suggests that intraoperative anesthetic management of awake craniotomy with remimazolam is safe. We compared the time to arousal and efficacy of anesthetic management with remimazolam and propofol during awake craniotomy. ⋯ Compared with propofol, remimazolam was associated with more rapid loss of consciousness and, after administration of flumazenil, with faster arousal times and improved intraoperative task performance.