Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2013
Randomized Controlled TrialThe effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery.
Surgery induces a variety of metabolic, endocrine, and immune changes collectively known as the "stress response," which may often lead to prolonged postoperative convalescence. Anesthetic management may modulate this physiological response, thus affecting the postoperative course. We hypothesized that the intraoperative administration of dexmedetomidine (DEX), a sympatholytic agent, would reduce the stress response and improve the quality of recovery in patients undergoing major surgery. ⋯ DEX infusion during multilevel spinal fusions moderately improved the quality of recovery and possibly reduced fatigue in the early postoperative period. Moreover, it reduced plasma levels of cortisol and IL-10 in comparison with the control group. Our sample size was not sufficient to detect differences either in the incidence of complications or in clinically relevant outcomes.
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J Neurosurg Anesthesiol · Jan 2013
GuidelineNeuroanesthesiology fellowship training: curricular guidelines from the Society for Neuroscience in Anesthesiology and Critical Care.
Standardization and accreditation of fellowship training have been considered in the field of neuroanesthesiology. A prior survey of members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) suggested strong support for accreditation and standardization. In response, SNACC created a Task Force that developed curricular guidelines for neuroanesthesiology fellowship training programs. These guidelines represent a first step toward standards for neuroanesthesiology training and will be useful if accreditation is pursued in the future.
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J Neurosurg Anesthesiol · Jan 2013
Letter Case ReportsMallampati class 0: visible epiglottis, a red herring.
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J Neurosurg Anesthesiol · Jan 2013
Real-time multimodal axillary vein imaging enhances the safety and efficacy of axillary vein catheterization in neurosurgical intensive care patients.
Controversy exists regarding the increased safety profile when ultrasound is used for central venous catheters inserted in the subclavian or axillary vein. The critically ill neurosurgical patient presents unique considerations for the optimal central line approach. ⋯ This series illustrates new and useful aspects of ultrasound use in transpectoral axillary vein catheterization: it requires minimal additional training; it combines the real time, in-plane technique with transverse, longitudinal, and Doppler color flow images; and it is used safely in the critically ill neurosurgical patient. The data on infraclavicular central venous catheters indicate decreased line sepsis, arterial punctures, and venous thrombosis while improving nursing care and patient comfort. This technique's potential for decreasing the risk of pneumothorax may make it a reasonable option for many critically ill patients in whom other central venous catheter approaches may not be ideal.