Noninvasive Brain Physiology Monitoring for Extreme Environments: A Critical Review
Our ability to monitor the brain physiology is advancing; however, most of the technology is bulky, expensive, and designed for traditional clinical settings. With long-duration space exploration, there is a need for developing medical technologies that are reliable, low energy, portable, and semiautonomous. Our aim was to review the state of the art for noninvasive technologies capable of monitoring brain physiology in diverse settings. A literature review of PubMed and the Texas Medical Center library sites was performed using prespecified search criteria to identify portable technologies for monitoring physiological asp...
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Review Articles Source Type: research

The Potential Benefits of Awake Craniotomy for Brain Tumor Resection: An Anesthesiologist’s Perspective
We present our interpretation of the evidence that we believe substantiates this proposition. However, due to the lack of direct evidence based on randomized-controlled trials and the heterogeneity of anesthetic techniques used for awake craniotomy, our perspective is largely speculative and hypothesis generating that needs to be validated or refuted by future quality research. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Review Articles Source Type: research

Safety Profile of 5-Aminolevulinic Acid as a Surgical Adjunct in Clinical Practice: A Review of 207 Cases From 2008 to 2013
Background: 5-Aminolevulinic acid (5-ALA) is used for brain tumor identification during surgery through fluorescence. Its use is linked to side effects such as photodermatosis, anemia, or plaquetopenia. Many institutions take very strict precautions to prevent them. Our hospital`s protocol mandates avoidance of direct sunlight during the first 24 hours only. Methods: Retrospective cohort observational study of 207 consecutive patients who underwent 5-ALA-guided brain tumor resection between 2008 and 2013, and compared with a control group of 53 patients without 5-ALA. Results: No skin reaction was reported. No difference w...
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Clinical Report Source Type: research

Changes in Energy Levels by Dexamethasone in Ischemic Hearts and Brains in Male Mice
Conclusions: The relationship between effects of glucocorticoids on ischemia-induced changes in energy levels and cellular viability was not clearly elucidated. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Laboratory Investigation Source Type: research

Effect of Loading Dose of Dexmedetomidine on Dynamic Cerebral Blood Flow Autoregulation in Patients With Intracranial Glial Neoplasms
This study is aimed to address this issue. Methods: Fifteen patients with unilateral supratentorial glial tumor (group S) and 15 patients without any intracranial pathology (group C) were included in this study. Transient hyperemic response testing was conducted bilaterally in both groups with transcranial color Doppler. Dynamic autoregulation was assessed with transient hyperemic response ratio (THRR) and strength of autoregulation (SA) at baseline and after infusion of inj. dexmedetomidine (1 mcg/kg) over 10 minutes. Results: THRR and SA values in the hemisphere that had tumor (group S) showed no difference from baseline...
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Comparison of the Effects of Propofol and Sevoflurane Combined With Remifentanil on Transcranial Electric Motor-evoked and Somatosensory-evoked Potential Monitoring During Brainstem Surgery
Background: We compared the effect of propofol and sevoflurane combined with remifentanil under comparable bispectral index (BIS) levels on transcranial electric motor-evoked potentials (TceMEPs) and somatosensory-evoked potentials (SSEPs) during brainstem surgery. Materials and Methods: A total of 40 consecutive patients (20 per group) undergoing brainstem surgery were randomly assigned to 2 groups receiving either 0.5 MAC sevoflurane or propofol at an effect-site concentration of 2.5 µg/mL for maintenance of anesthesia. Remifentanil was administered to both groups at a rate of 0.25 to 0.35 μg/kg/min along with c...
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

The Effects of Flumazenil After Midazolam Sedation on Cerebral Blood Flow and Dynamic Cerebral Autoregulation in Healthy Young Males
Conclusions: Contrary to our hypothesis, the present results suggest that despite complete antagonism of the sedative effects of midazolam, flumazenil would not reverse the alterations in cerebral circulation induced by midazolam. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - September 5, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Comparison of the I-gel Laryngeal Mask Airway With the LMA-Supreme for Airway Management in Patients Undergoing Elective Lumbar Vertebral Surgery: Erratum
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Erratum Source Type: research

Transesophageal Echocardiography as a Guide to Central Venous Catheter Placement in a Patient With Functional Ventriculo-atrial CSF Shunt
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Anesthetic Management of a Child With Severe Dystonia and G6PD Deficiency for Deep Brain Stimulation
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Selective Right Lower Lobe Isolation to Control CO2 in a Patient With Raised ICP Undergoing Craniotomy
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Acute Changes in the Cerebral Oximetry During Intraoperative Seizures: An NIRS-based Observation
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Near-Infrared Spectroscopy Changes During Embolization of a Vein of Galen Malformation
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Cardiovascular Collapse After Induction
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Paravertebral Block: Sole Anesthetic Technique for Lumbar Discectomy in a Patient With Limited Cardiac Reserve
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Spinal Deformities; the Essentials
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Book Review Source Type: research

Seven AVMs Tenets and Techniques for Resection
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Book Review Source Type: research

Vascular Anaesthesia
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Departments: Book Review Source Type: research

Development of a Clinically Applicable Protocol for Assessment of Hypoxic Response Through Measurement of the Endogenous Gasotransmitter Hydrogen Sulfide in Human Plasma
Background: Gasotransmitters are endogenously made, biologically active gases with unique physiological properties. In addition to participation in the hypoxic respiratory reflex of the carotid body, the gasotransmitter hydrogen sulfide (H2S) is thought to play a role in more localized vasodilatory hypoxic tissue responses. This pilot project describes a methodology suitable to the clinical environment that allows for H2S gas capture in human plasma utilizing the fluorescent trapping agent dansyl azide. Methods: Under an IRB-approved pilot project, 10 healthy male volunteers were spontaneously ventilated on room air, hypox...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Reports Source Type: research

A New Method of Airway Management in Patients Undergoing Gasserian Ganglion Thermal Coagulation: Preliminary Results
Conclusions: This preliminary study suggests that manually assisted ventilation with pure oxygen using a nasopharyngeally placed tube seems to be a sufficient airway management technique during thermal coagulation of the Gasserian ganglion. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Reports Source Type: research

Rapid Anticoagulation Reversal With Prothrombin Complex Concentrate Before Emergency Brain Tumor Surgery
Background: Brain tumors may become symptomatic due to intracranial hypertension and patients may present to emergency departments in life-threatening conditions. Hence, emergency brain tumor surgery has to be considered, but sufficient hemostasis has to be present when initiating surgical procedures. Impaired hemostasis because of oral anticoagulation for the treatment of cardiovascular diseases is encountered in a growing number of patients. Here we present the first case series of anticoagulated patients receiving prothrombin complex concentrate (PCC) to rapidly restore hemostasis and facilitate emergency brain tumor su...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Reports Source Type: research

The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom: Is there a Consensus?: A National Survey
Conclusions: We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Special Article Source Type: research

Aneurysmal Subarachnoid Hemorrhage
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation ane...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Review Article Source Type: research

Preischemic Administration of Sevoflurane Does not Exert Dose-dependent Effects on the Outcome of Severe Forebrain Ischemia in Rats
We previously showed that preischemic administration of high-dose isoflurane worsened the outcome from severe forebrain ischemia in rats. Conversely, high doses of sevoflurane have been reported to improve the outcome from forebrain ischemia when the insult is moderate. To clarify the dose-dependent effects of sevoflurane on severe forebrain ischemia, we performed an outcome study using an identical protocol to that in our previous study with isoflurane. Fasting male Sprague-Dawley rats underwent surgical preparation for forebrain ischemia under halothane anesthesia. Anesthesia was changed to fentanyl/nitrous oxide to elim...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Laboratory Investigation Source Type: research

Dexmedetomidine as an Anesthetic Adjuvant in Patients Undergoing Transsphenoidal Resection of Pituitary Tumor
Background: Transnasal transsphenoidal (TNTS) resection of pituitary tumors involves wide fluctuation in hemodynamic parameter and causes hypertension and tachycardia due to intense noxious stimuli during various stages of surgery. None of routinely used anesthetic agents effectively blunts the undesirable hemodynamic responses, and therefore usually there is a need to use increased doses of anesthetic agents. Dexmedetomidine (DEX) an α-2 adrenergic receptor agonist, because its sympatholytic and antinociceptive properties may ensure optimal intraoperative hemodynamic stability during critical moments of surgical man...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Measuring and Improving First Case On-Time Starts and Analysis of Factors Predicting Delay in Neurosurgical Operating Rooms
Conclusion: The quality improvement project, which was implemented in 2 phases, successfully increased the FCOTS rate in our neurosurgical ORs from 33% to 68%. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

ProSeal Laryngeal Mask Airway Attenuates Systemic and Cerebral Hemodynamic Response During Awakening of Neurosurgical Patients: A Randomized Clinical Trial
Background: Extubation and emergence from anesthesia may lead to systemic and cerebral hemodynamic changes that endanger neurosurgical patients. We aimed to compare systemic and cerebral hemodynamic variables and cough incidence in neurosurgery patients emerging from general anesthesia with the standard procedure (endotracheal tube [ETT] extubation) or after replacement of the ETT with a laryngeal mask airway (LMA). Materials and Methods: Forty-two patients undergoing supratentorial craniotomy under general anesthesia were included in a randomized open-label parallel trial. Patients were randomized (sealed envelopes labele...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Cerebral Glucose Metabolism and Sedation in Brain-injured Patients: A Microdialysis Study
Background: Disturbed brain metabolism is a signature of primary damage and/or precipitates secondary injury processes after severe brain injury. Sedatives and analgesics target electrophysiological functioning and are as such well-known modulators of brain energy metabolism. Still unclear, however, is how sedatives impact glucose metabolism and whether they differentially influence brain metabolism in normally active, healthy brain and critically impaired, injured brain. We therefore examined and compared the effects of anesthetic drugs under both critical (1 mmol/L) extracellular brain glucose levels. Methods: We perform...
Source: Journal of Neurosurgical Anesthesiology - June 13, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Guest Reviewer Acknowledgment
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Guest Reviewer Acknowledgment Source Type: research

Dexamethasone PONV-Prophylaxis Alters the Hypothalamic-Pituitary-Adrenal Axis After Transsphenoidal Pituitary Surgery
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Dexamethasone and Hypothalamic-Pituitary-Adrenal Axis Suppression After Transsphenoidal Pituitary Surgery
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Life-threatening Complication of Intraoperative Valsalva Maneuver in an Infant
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Use of Tracheal Tube as a Splint to Prevent Intraoperative Kinking of Gas Sampling Line
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

2014 SNACC Annual Meeting Report
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: SNACC Meeting Report Source Type: research

Oxford Higher Specialty Training: Advanced Training in Anaesthesia: The Essential Curriculum
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Book Review Source Type: research

Journal Club
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Departments: Journal Club Source Type: research

Determination of EC95 of Remifentanil for Smooth Emergence From Propofol Anesthesia in Patients Undergoing Transsphenoidal Surgery
Background: In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. Materials and Methods: A total of 41 patients undergoing transsphenoidal hypophysectomy, aged 20 to 65 years, with an ASA physical status of I or II, were enrolled. For all partic...
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Clinical Report Source Type: research

Detection of Elevated Intracranial Pressure in Robot-assisted Laparoscopic Radical Prostatectomy Using Ultrasonography of Optic Nerve Sheath Diameter
Conclusions: This study demonstrates an increase in ONSD in patients undergoing RALRP. These findings confirm ICP rises to ≥20 mm Hg during RALRP surgery. This increase in ICP is significantly associated with increasing MAP. Patients with intracranial pathology should be counseled to the risks RALRP may pose with regard to intracranial hypertension. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Responses of Heart Rate Variability to Acute Pain After Minor Spinal Surgery: Optimal Thresholds and Correlation With the Numeric Rating Scale
Background: The autonomic nervous system is influenced by many stimuli including pain. Heart rate variability (HRV) is an indirect marker of the autonomic nervous system. Because of paucity of data, this study sought to determine the optimal thresholds of HRV above which the patients are in pain after minor spinal surgery (MSS). Secondly, we evaluated the correlation between HRV and the numeric rating scale (NRS). Methods: Following institutional review board approval, patients who underwent MSS were assessed in the postanesthesia care unit after extubation. A laptop containing the HRV software was connected to the ECG mon...
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Trigeminocardiac Reflex: The Current Clinical and Physiological Knowledge
The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requi...
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Review Articles Source Type: research

Cerebrovascular Reactivity to Carbon Dioxide Under Anesthesia: A Qualitative Systematic Review
Conclusions: Our systematic review showed that within the clinical anesthesia concentrations, CVR-CO2 is maintained under both propofol and inhalational agents. However, most of the information available is from non-neurosurgical patients and these studies also suffer from significant methodological heterogeneity. Therefore, we were limited by the amount and the quality of data available for this review. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Review Articles Source Type: research

Neuroanesthesiology Update
This survey provides a synopsis of new findings, recurring themes, and data that may initiate practice changes in the perioperative care of neurosurgical patients and critically ill patients with neurological diseases. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - March 9, 2015 Category: Anesthesiology Tags: Review Articles Source Type: research

Effects of Anesthetics on Brain Circuit Formation: Erratum
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - January 1, 2015 Category: Anesthesiology Tags: Erratum Source Type: research

Neurosurgery Tricks of the Trade: Spine and Peripheral Nerves
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - January 1, 2015 Category: Anesthesiology Tags: Departments: Book Review Source Type: research

Placement of Lumbar Subarachnoid Drain in the Sitting Position: A Technical Difficulty
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - January 1, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Central Cord Syndrome: A Rare Neurological Complication Following Hypotension During General Anesthesia in an Elderly Patient
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - January 1, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research

Apnea During Awake Epilepsy Surgery: An Unusual Cause for a Rare Complication
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - January 1, 2015 Category: Anesthesiology Tags: Departments: Correspondence Source Type: research