Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Jul 2013
ReviewSupratentorial intracerebral hemorrhage: a review of the underlying pathophysiology and its relevance for multimodality neuromonitoring in neurointensive care.
Supratentorial intracerebral hemorrhage (ICH) is a devastating condition with high morbidity and mortality. There are currently no proven pharmacological therapies for ICH, and the role of surgery is controversial. In the neurointensive care setting, management currently focuses on optimization of systemic physiology to offer neuroprotection by maintenance of adequate cerebral perfusion and substrate delivery, using targets derived principally from traumatic brain injury. ⋯ Here, we review the developments in neuromonitoring and their application to ICH, highlighting the importance of multimodality neuromonitoring to comprehensively assess cerebral perfusion, oxygenation, and metabolic status as well as offer an extended window for the prevention, early detection, and treatment of secondary neuronal injury and complications such as hematoma expansion. Technical advances will likely lead to the development of noninvasive monitors that deliver continuous measurement of cerebral hemodynamics, oxygenation, and metabolism over multiple regions of interest simultaneously. A key future priority will be to provide high-quality robust evidence that multimodality monitoring-guided treatment can lead to improved outcome.
-
We provide a review of both clinical and basic science literature from 2012 relevant to care of the patient with neurological disease. Our review addresses the following major areas: general neurosurgical procedures, stroke, traumatic brain injury, spine surgery, anesthetic neurotoxicity, neuroprotective strategies, electrophysiological monitoring, history, and graduate medical education. We have focused on research describing new and innovative concepts and recurring themes. This review is intended to be of interest to those working in the clinical arena and also to neuroscientists.
-
J Neurosurg Anesthesiol · Jan 2013
ReviewAnemia and transfusion after aneurysmal subarachnoid hemorrhage.
Anemia is common in patients with aneurysmal subarachnoid hemorrhage (SAH), but these patients have constituted only a small fraction of those studied in large trials of anemia and transfusion. Unlike other critically ill patients, those with SAH face a well-defined risk of vasospasm and cerebral ischemia in the weeks after their hemorrhage. ⋯ Most of these data are observational in nature, although 1 recent study demonstrated the safety and feasibility of maintaining relatively high transfusion thresholds in patients with SAH. Larger, randomized trials are needed to determine at what levels of anemia patients with SAH might benefit from transfusion, the optimal timing of transfusion, and how to identify those patients who are most likely to benefit.
-
Despite the fact that it has been used since the 1960s in diseases associated with brain edema and has been investigated in >150 publications on head injury, very little has been published on the outcome of osmotherapy. We can only speculate whether osmotherapy improves outcome, has no effect on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. ⋯ These drawbacks, and the fact that the most recent Cochrane meta-analyses of osmotherapy in brain edema and stroke could not find any beneficial effects on outcome, make routine use of osmotherapy in brain edema doubtful. Nevertheless, the use of osmotherapy as a temporary measure may be justified to acutely prevent brain stem compression until other measures, such as evacuation of space-occupying lesions or decompressive craniotomy, can be performed. This article is the Con part in a Pro-Con debate in the present journal on the general routine use of osmotherapy in brain edema.
-
J Neurosurg Anesthesiol · Oct 2012
Review Historical ArticleSnapshot of 1973 and 1974: critical thinkers and contemporary research ideas in neurosurgical anesthesia during the first years of SNACC.
The year 2012 marks the 40th anniversary of the Society of Neuroscience in Anesthesiology and Critical Care (SNACC). To celebrate this occasion, we provide a review, speculative synthesis, and commentary addressing research relevant to neurosurgical anesthesiology in 1973 and 1974--the early years of SNACC. We address topics such as effects of anesthetic drugs, neuroprotection, cerebral physiology, and monitoring as they relate to the perioperative care of neurosurgical patients or patients experiencing or at risk for neurological disorders. Our hypothesis is that a review of these publications will identify the foundations of research and practice concepts that persist until today and will also identify concepts that have dwindled or outright disappeared.