Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2014
Risk of Needle-Stick Injuries Associated With the Use of Subdermal Needle Electrodes During Intraoperative Neurophysiologic Monitoring.
Subdermal needle electrodes are commonly used during intraoperative neurophysiologic monitoring (IONM). However, there is an associated risk of needle-stick exposure to the IONM technologist as well as other operating room personnel. We performed a retrospective study to investigate the incidence and circumstances of needle sticks related to the use of subdermal needle electrodes. ⋯ Needle-stick exposure from subdermal needle electrodes during IONM is an infrequent but distressing event occurring in 0.34% of our study group and was not limited to the IONM technologist. Although no infections occurred as a result of needle-stick exposure in this study, steps to minimize needle sticks should be taken during IONM.
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J Neurosurg Anesthesiol · Jan 2014
Observational StudyDay Surgery Craniotomy for Unruptured Cerebral Aneurysms: A Single Center Experience.
Ambulatory day surgery is an evolving specialty in line with demands of modern medicine, health care services, and economics, but its role in neurovascular surgery remains controversial. The purpose of this study was to describe our experience of patients undergoing elective clipping of intact cerebral aneurysms as day surgery. ⋯ Our data demonstrates that surgical clipping of unruptured cerebral aneurysms may be performed in an outpatient setting. Careful selection of day surgery candidates and postoperative assessment for complications is needed. Further research is needed to identify potential risk factors and to target patient subgroups for successful ambulatory surgery.
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J Neurosurg Anesthesiol · Jan 2014
Survey of Anesthesiologists Practicing in American Neurointensive Care Units as Neurointensivists.
A group of anesthesiologists practice as intensivists in neurointensive care units (NeuroICU). The current nature and implications of the role of anesthesiology-based neurointensivist remain unclear. The purpose of this survey was to assess today's practice environment of anesthesiology-based neurointensivists as a framework for future study. ⋯ Anesthesiology-based neurointensivists currently represent a small subgroup within the rapidly growing neurointensivist workforce in the United States and consider neurocritical care a valuable aspect of their career. Promoting subspecialty training in neurocritical care among anesthesiologists may provide an opportunity for new patient-care frontiers and address the increasing need for NeuroICU physicians.
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J Neurosurg Anesthesiol · Jan 2014
Effect of Tracheostomy Timing on Clinical Outcome in Neurosurgical Patients: Early Versus Late Tracheostomy.
The optimal timing of tracheostomy in neurosurgical patients is not well established. This retrospective study was conducted to determine the effect of the timing of tracheostomy on clinical outcome in mechanically ventilated neurosurgical patients admitted to the surgical intensive care unit (ICU). ⋯ Early tracheostomy reduced the MV duration, ICU LOS, and incidence of VAP in critically ill neurosurgical patients. However, early tracheostomy did not reduce either the ICU or hospital mortality.
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J Neurosurg Anesthesiol · Jan 2014
Observational StudyCan Baroreflex Sensitivity and Heart Rate Variability Predict Late Neurological Outcome in Patients With Traumatic Brain Injury?
Previous studies have suggested that depressed heart rate variability (HRV) and baroreflex sensitivity (BRS) are associated with early mortality and morbidity in patients with acute brain injuries of various etiologies. The aim of the present study was to assess changes in HRV and BRS in isolated traumatic brain injury (TBI), with the hypothesis that measurement of autonomic nervous system dysfunction can provide prognostic information on late neurological outcome. ⋯ HRV and BRS measures in TBI patients during intensive care treatment, including sedative, analgesic, and vasoactive drugs, may identify patients with poor late neurological outcome.