Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2025
Meta AnalysisEnhanced Recovery After Surgery for Craniotomies: A Systematic Review and Meta-analysis.
The efficacy of the enhanced recovery after surgery (ERAS) protocols in neurosurgery has not yet been established. We performed a systematic review and meta-analysis of randomized controlled trials to compare the effects of ERAS protocols and conventional perioperative care on postoperative outcomes in patients undergoing craniotomy. The primary outcome was postoperative length of hospital stay. ⋯ Other outcomes, including postoperative complications, did not differ between ERAS and conventional care groups. ERAS protocols may be superior to conventional perioperative care in craniotomy patients in terms of lower length of hospital stay, lower incidence of PONV, and improved postoperative pain scores. Further randomized trials are required to identify the impact of ERAS protocols on the quality of recovery after craniotomy.
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J Neurosurg Anesthesiol · Jan 2025
ReviewAntiplatelet Agents in Endovascular Neurointerventional Procedures.
Minimally invasive, image-guided endovascular procedures are becoming increasingly prevalent as techniques and technologies have advanced, particularly within the realm of neurovascular interventions. Endovascular approaches ubiquitously result in endothelial injury with subsequent risk of thromboembolic complications. Periprocedural antiplatelet agent use is an integral component of the management of patients undergoing endovascular neurointerventional procedures. ⋯ This focused review will discuss the major mechanisms of action of antiplatelet agents, and their clinical indications and management in the periprocedural neurointerventional setting. Despite the importance of antiplatelet agents in the management of neurointerventional patients, many questions remain. Further research and clinical expertise are needed to establish standardized, procedure-specific, antiplatelet regimens as well as standardized monitoring of antiplatelet agent regimen efficacy and safety.
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J Neurosurg Anesthesiol · Jan 2025
Morphine Preconditioning Alleviates Ischemia/Reperfusion-induced Caspase-8-dependent Neuronal Apoptosis through cPKCγ-NF-κB-cFLIPL Pathway.
Perioperative cerebral ischemia/reperfusion injury is a major contributor to postoperative death and cognitive dysfunction in patients. It was reported that morphine preconditioning (MP) can mimic ischemia/hypoxia preconditioning to protect against ischemia/reperfusion injury. However, the mechanism of MP on the ischemia/reperfusion-induced neuronal apoptosis has not been fully clarified. ⋯ MP alleviates ischemia/reperfusion-induced Caspase 8-dependent neuronal apoptosis through the cPKCγ-NF-κB-cFLIP L pathway.