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Neuroanesthesia and outcomes: evidence, opinions, and speculations on clinically relevant topics
The objective of this review is to identify outstanding topics most relevant to neuroanesthesia practice and patient outcomes. We discuss the role of awake craniotomy, choice of general anesthetic agents, monitoring of anesthetic ‘depth’, mannitol-induced diuresis, neurophysiological monitoring, hyperventilation, and cerebral hypoperfusion. Recent findings Awake craniotomy, although a technique likely underused, is associated with enhanced recovery after surgery and prolonged survival after brain tumor resection compared with surgery under general anesthesia. The choice of general anesthetic must balance patient and...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Cerebral protection during neurosurgery and stroke
This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain surgery and in patients with acute stroke. Recent findings: With varying degrees of success, numerous pharmacological and nonpharmacological therapies have been employed to provide neuroprotection for patients during the perioperative period and after acute ischemic stroke (IAS). Recent studies have failed to demonstrate neuroprotective effects of intraoperative remifentanil or propofol use, although hypertonic saline may provide better brain relaxation than mannitol during elective intracranial surgery for tumor. Magnesi...
Source: Current Opinion in Anaesthesiology - September 3, 2015 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Keith J. Ruskin Source Type: research

Update on anesthetic neuroprotection
Purpose of review: Perioperative cerebral injury can result in a wide range of clinical consequences from subtle cognitive changes to devastating or fatal strokes. Although the overall incidence of perioperative stroke is low, the large and growing number of aging patients undergoing surgery and anesthesia is placing an increasing number of vulnerable patients at risk. The purpose of this review is to evaluate recent evidence concerning the use of pharmacological and nonpharmacological strategies to protect against perioperative cerebral injury. Recent findings: Although a growing body of preclinical literature suggests th...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research

New therapy in cardioprotection
Purpose of review: An increasing number of patients are presenting for major surgery with cardiovascular comorbidities. Evidence of myocardial injury was found in 8% of all noncardiac surgery patients older than 45 years and was associated with adverse outcome. For this reason, there has been a lot of interest in finding and evaluating effective cardioprotective interventions. Recent findings: Current evidence suggests that statins, volatile anesthetic agents, and propofol are cardioprotective. Beta blockers reduce myocardial injury, but the resultant hypotension may contribute to the increased all-cause mortality and stro...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research