Anesthesia in Children: Perspectives From Nonsurgical Pediatric Specialists
The Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) study investigates the potential neurotoxicity of anesthetics in the pediatric population. At a recent symposium, a panel of nonsurgical physicians from the disciplines of radiology, neurology, cardiology, and critical care discussed the role anesthesia plays in their respective practices. To execute diagnostic studies and/or therapeutic interventions in each of these disciplines, general anesthesia is oftentimes required for pediatric patients. Given recent publications in the literature suggesting the potential for neurotoxicity following anesthesia in pediatri...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Pediatric Surgeons and Anesthesiologists Expand the Dialogue on the Neurotoxicity Question, Rationale for Early and Delayed Surgeries, and Practice Changes While Awaiting Definitive Evidence
The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved techno...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Engaging Stakeholders in Research Related to Anesthesia and Neurodevelopment in Children
The Fourth PANDA symposium on Anesthesia and Neurodevelopment in Children invited 4 leaders in community engagement and federal government collaboration to share their experiences with overcoming challenges in promoting public health issues. There continues to be emerging evidence from laboratory findings in animal models demonstrating neurotoxic effects and neurodevelopmental changes from early exposure to anesthetic and sedative drugs, but studies in humans have been very limited and inconclusive. Although definitive recommendations for clinical care still cannot be made given the limitations in the clinical data, the ne...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Neurodevelopmental Outcomes After Initial Childhood Anesthetic Exposure Between Ages 3 and 10 Years
Conclusions:Initial exposure to anesthesia after age 3 had no measurable effects on language or cognitive function. Decreased motor function was found in children initially exposed after age 3 even after accounting for comorbid illness and injury history. These results suggest that there may be distinct windows of vulnerability for different neurodevelopmental domains in children. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Postoperative Cognitive Function Following General Versus Regional Anesthesia: A Systematic Review
The effect of anesthetic technique on postoperative outcomes remains in question. This systematic review compares the role of regional versus general anesthesia, with a particular focus on postoperative cognitive function. Potentially relevant articles were identified by searching publicly available computerized databases for this systematic review. Any surgical procedure was accepted with the exception of cardiac, carotid, and neurosurgical procedures. Any regional anesthetic technique was accepted unless combined with a general anesthetic or in conjunction with propofol as a sedative. Any measure of postoperative cogniti...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Isoflurane Impairs the Capacity of Astrocytes to Support Neuronal Development in a Mouse Dissociated Coculture Model
Conclusions:Isoflurane interferes with the ability of cultured astrocytes to support neuronal growth. This finding represents a potentially novel mechanism through which general anesthetics may interfere with brain development. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Review: Effects of Anesthetics on Brain Circuit Formation
The results of several retrospective clinical studies suggest that exposure to anesthetic agents early in life is correlated with subsequent learning and behavioral disorders. Although ongoing prospective clinical trials may help to clarify this association, they remain confounded by numerous factors. Thus, some of the most compelling data supporting the hypothesis that a relatively short anesthetic exposure can lead to a long-lasting change in brain function are derived from animal models. The mechanism by which such changes could occur remains incompletely understood. Early studies identified anesthetic-induced neuronal ...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Clinical Research Into Anesthetic Neurotoxicity: Does Anesthesia Cause Neurological Abnormalities in Humans?
General anesthetics mitigate distress and exaggerated hemodynamic responses to pain and stressful stimulation, allowing surgery and diagnostic procedures to be performed worldwide in millions of children every year. Emerging studies, mainly carried out in early postnatal laboratory animals, demonstrate widespread neuronal elimination, alteration in neuronal circuitry, and long-term neurological disabilities following exposure to all commonly used sedatives and anesthetics. These findings have raised concerns among parents, anesthesiologists, neuroscientists, and government regulators about the safety of anesthetic drugs in...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Report of the Fourth PANDA Symposium on “Anesthesia and Neurodevelopment in Children”
On April 12, 2014, the Pediatric Anesthesia and NeuroDevelopment Assessment (PANDA) study team held its fourth biennial scientific symposium at Morgan Stanley Children’s Hospital of New York (MS-CHONY). The symposium was organized by the PANDA study team and co-sponsored by the Morgan Stanley Children’s Hospital of New York-Presbyterian and the Department of Anesthesiology of Columbia University. The PANDA symposium has become a platform to review current preclinical and clinical data related to anesthetic neurotoxicity, to discuss relevant considerations in study design and approaches to future research among ...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Introduction to “Anesthesia and Neurodevelopment in Children”: A Supplement From the Fourth PANDA Symposium
No abstract available (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Departments: Supplement: Fourth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium Source Type: research

Intraoperative Monitoring of Brain Tissue Oxygenation During Arteriovenous Malformation Resection
Conclusions:The PtiO2/PaO2 ratio is a better indicator than absolute PtiO2 in detecting tissue hypoxia in mechanically ventilated patients. Intraoperative monitoring showed tissue hypoxia in the margins of AVMs and in the distant ipsilateral brain as the most common finding. Surgical removal of AVMs induces a significant improvement in the oxygenation status in both areas. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Report Source Type: research

The Brain Relaxation and Cerebral Metabolism in Stroke Volume Variation–directed Fluid Therapy During Supratentorial Tumors Resection: Crystalloid Solution Versus Colloid Solution
Background:Compared with goal-directed crystalloid therapy, goal-directed colloid therapy during high-risk surgery may improve postoperative outcome. Whether intraoperative fluid therapy based on goal-directed protocol with different types of fluid has distinctive effects on brain relaxation and cerebral metabolism during craniotomy remains unclear. Methods:Forty patients with supratentorial brain tumors undergoing craniotomy were randomly assigned to either a Ringer’s Lactate-based goal-directed group (LR group, n=20) or a 6% hydroxyethyl starch–based goal-directed group (HES group, n=20). The goal was achieve...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Perioperative Glycemic Status of Adult Traumatic Brain Injury Patients Undergoing Craniotomy: A Prospective Observational Study
Background:Patients of traumatic brain injury (TBI) may have hyperglycemia and when they undergo craniotomy, hyperglycemia may be exacerbated and worsen outcome. However, epidemiology of perioperative hyperglycemia in these patients is unknown. The epidemiological study has been undertaken to address the correlation between intraoperative blood glucose variability in nondiabetic adult TBI patients undergoing craniotomy with the severity and type of brain trauma and patients’ demographic variables. Methods:A total of 200 adult nondiabetic patients undergoing emergency craniotomy for TBI were recruited in this prospect...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Direct Comparison of the Effect of Desflurane and Sevoflurane on Intraoperative Motor-evoked Potentials Monitoring
Background:During spinal surgery, intraoperative monitoring of motor-evoked potentials (MEPs) is a useful means of assessing the intraoperative integrity of corticospinal pathways. However, MEPs are known to be particularly sensitive to the suppressive effects of inhalational halogenated anesthetic agents. Objective:To investigate the effects of increasing end-tidal concentrations of desflurane and sevoflurane anesthesia in a background of propofol and remifentanil with multipulse cortical stimulation on intraoperative monitoring of MEPs. Methods:In this randomized crossover trial, 14 consecutive patients (7 in each arm) u...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Prognostic Value of Somatosensory-evoked Potentials and CT Scan Evaluation in Acute Traumatic Brain Injury
Background:The aim of this study is to assess whether a complete analysis of all early cortical somatosensory-evoked potentials (SEPs) components and computed tomography (CT) scan features can provide a better prognostic measure than the early cortical component N20/P25 alone, in patients with severe head injury. Materials and Methods:We studied 81 consecutive patients admitted to intensive care unit with diagnosis of severe head injury. All patients underwent neurophysiological assessment with SEPs and electroencephalography within the first 6 days after trauma. The marginal effect of each variable on Glasgow Outcome Scal...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Effects of Remifentanil on In-Hospital Mortality and Length of Stay Following Clipping of Intracranial Aneurysm: A Propensity Score-matched Analysis
Background:Remifentanil is an ultrashort-acting µ-opioid receptor agonist and is especially suitable for neuroanesthesia. We previously reported that general anesthesia with remifentanil for brain tumor resection was associated with lower postoperative mortality and shorter postoperative length of stay (LOS) when compared with surgeries without remifentanil. This phenomenon may also exist during clipping of intracranial aneurysms (ICAs), where brain tissue frequently suffers ischemia and reperfusion injury. We performed a propensity score-matching study to compare in-hospital mortality and postoperative LOS with and ...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Impact of Anesthesia on Mortality During Endovascular Clot Removal for Acute Ischemic Stroke
Background:Endovascular clot retrieval is a technique available for removing intracranial arterial occlusions in acute ischemic stroke (AIS). This rescue therapy can be performed with moderate conscious sedation (CS) or general anesthesia (GA). The effect of GA on clinical outcome in AIS remains controversial. Therefore, we retrospectively investigated whether the use of CS or GA during endovascular intervention for AIS influenced outcomes. Methods:Patients who underwent emergent endovascular intervention for intracranial arterial occlusion during the years 2006 to 2012 were included in this study. Statistical analysis usi...
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Perioperative Care of Patients at High Risk for Stroke during or after Non-Cardiac, Non-Neurologic Surgery: Consensus Statement from the Society for Neuroscience in Anesthesiology and Critical Care*
This document is supported by the American Society of Anesthesiologists.**Perioperative stroke can be a catastrophic outcome for surgical patients and is associated with increased morbidity and mortality. This consensus statement from the Society for Neuroscience in Anesthesiology and Critical Care provides evidence-based recommendations and opinions regarding the preoperative, intraoperative, and postoperative care of patients at high risk for the complication. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - October 1, 2014 Category: Anesthesiology Tags: Special Article Source Type: research