Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2022
Randomized Controlled TrialDiclofenac Is Superior to Paracetamol in Postoperative Pain Scores and Analgesic Consumption in Supratentorial Craniotomy With No Difference in Platelet and Clot Function: A Prospective Randomized Controlled Trial.
The use of nonsteroidal anti-inflammatory drugs in neurosurgery remains controversial because of potential risk of hematoma formation secondary to platelet dysfunction. This study aimed to investigate the efficacy and safety of diclofenac compared with paracetamol for the management of postcraniotomy pain. ⋯ Compared with paracetamol, diclofenac sodium provided more effective postoperative analgesia at 24 hours with no evidence of adverse effects on coagulation profiles in patients undergoing craniotomy for supratentorial tumors.
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J Neurosurg Anesthesiol · Jul 2022
Randomized Controlled TrialSafety of Nitrous Oxide Anesthesia in a Selected Group of Patients Undergoing Neurosurgery: An Exploratory Subgroup Analysis of the ENIGMA Trials.
The Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia (ENIGMA)-I and ENIGMA-II were randomized clinical trials that assessed the safety of nitrous oxide anesthesia in patients undergoing noncardiac surgery. In this study, we performed an exploratory pooled analysis of both ENIGMA trials to assess the safety of nitrous oxide in a selected group of patients undergoing neurosurgery. ⋯ Nitrous oxide did not increase the risk of postoperative complications or prolonged length of hospital stay in the neurosurgical cohort enrolled in the ENIGMA-I and ENIGMA-II trials.
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J Neurosurg Anesthesiol · Jul 2022
ReviewUnder the Helmet: Perioperative Concussion-Review of Current Literature and Targets for Research.
Patients with recent concussion experience disruption in neurocellular and neurometabolic function that may persist beyond symptom resolution. Patients may require anesthesia to facilitate diagnostic or surgical procedures following concussion; these procedures may or may not be related to the injury that caused the patient to sustain a concussion. As our knowledge about concussion continues to advance, it is imperative that anesthesiologists remain up to date with current principles. This Focused Review will update readers on the latest concussion literature, discuss the potential impact of concussion on perianesthetic care, and identify knowledge gaps in our understanding of concussion.
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J Neurosurg Anesthesiol · Jul 2022
Inadvertent Burst Suppression During Total Intravenous Anesthesia in 112 Consecutive Patients Undergoing Spinal Instrumentation Surgery: A Retrospective Observational Quality Improvement Project.
The incidence and quantification of inadvertent electroencephalographic burst suppression during total intravenous anesthesia (TIVA) for spine instrumentation surgery has not previously been reported. ⋯ High rates and prolonged periods of inadvertent burst suppression may be prevalent during spine instrumentation surgery with TIVA. Our findings suggest that usage of electroencephalography alone is incomplete without prompt interpretation and intervention, mandating close communication between neuromonitoring and anesthesia teams. The dose-response relationship between burst suppression, total time spent in maximal burst suppression, and their association with delirium warrants further evaluation.