Journal of neurosurgical anesthesiology
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Adequate analgesia is known to improve outcomes after spine surgery. Despite recent attention highlighting the negative effects of narcotics and their addiction potential, opioids have been the mainstay of management for providing analgesia following spine surgeries. However, side effects including hyperalgesia, tolerance, and subsequent dependence restrict the generous usage of opioids. ⋯ Neuraxial narcotics offer enhanced analgesia for a longer duration with lower dosage and side effect profiles compared with systemic opioid administration. Fascial compartment blocks are increasingly used as they provide effective analgesia with fewer adverse effects. In this narrative review, we will discuss multimodality analgesic regimens incorporating opioid-sparing adjuvants to manage pain after spine surgery.
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J Neurosurg Anesthesiol · Jan 2022
ReviewPrecision Medicine in Acute Brain Injury: A Narrative Review.
Over the past few years, the concept of personalized medicine has percolated into the management of different neurological conditions. Improving outcomes after acute brain injury (ABI) continues to be a major challenge. Unrecognized individual multiomic variations in addition to multiple interacting processes may explain why we fail to observe comprehensive improvements in ABI outcomes even when applied treatments appear to be beneficial logically. ⋯ The challenge is to incorporate all the information obtained from genomic studies, other omic data, and individual variability into a practical tool that can be used to assist clinical decision-making. The effective execution of such strategies, which is still far away, requires the development of protocols on the basis of these complex interactions and strict adherence to management protocols. In this review, we will discuss various omics and physiological targets to guide individualized patient management after ABI.
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J Neurosurg Anesthesiol · Jan 2022
ReviewA Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study.
External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. ⋯ In summary, the published literature related to EVD insertion and maintenance, and reported EVD hospital practices and policies, primarily focus on reducing EVD-associated infections. Still, overall adherence of hospital EVD policies to guideline recommendations is modest. To promote a culture of EVD safety, clinicians should focus on reducing all EVD-associated adverse events.
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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 (COVID)-19 pandemic has been an enormous global health burden, resulting in hundreds of millions of documented infections and more than 3 million deaths. Increasing reports characterizing the effects of COVID-19 in pediatric populations have been published during the course of the pandemic. We performed a systematic review to assess the scope of diagnosis, treatment, and management of COVID-19 in pediatric patients. ⋯ Pediatric COVID-19 infection is mild and frequently asymptomatic. There is a low risk of severe illness or death in children who contract COVID-19. High-quality studies should be conducted to develop best practices for prevention, diagnosis, and management of symptomatic illness.