Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia.

Introduction: This study compares the postsurgical course of frontotemporal craniotomies conducted "awake" under regional anesthesia (RA) versus "asleep" under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects.

Methods: We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded.

Awake minimally invasive transforaminal lumbar interbody fusion with a pedicle-based retraction system.

Objective: Recently there has been increasing interest in the use of regional anesthesia for minimally-invasive transforaminal lumbar interbody fusion (TLIF) and laminectomy, with the goal of reducing the side effects and risks associated with general anesthesia and also to improve patient satisfaction. The goal of this technical note is to describe important perioperative aspects to safely perform an awake spine surgery and to describe a novel technique to preform minimally-invasive TLIF using a pedicle-based retraction system.

Methods: We report our patient selection criteria, perioperative anesthesia protocol and surgical technique for awake TLIF with the Maximum Access Surgery (MAS) TLIF Retraction System.

Awake Craniotomy in a Patient with Previously Diagnosed Post-Traumatic Stress Disorder.

Background: Awake craniotomy (AC) with brain mapping has been successfully used for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough presurgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery because these patients may be less cooperative to tolerate AC.

Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided epidural blood patch.

Background: A persistent cerebrospinal fluid leak after spinal surgery can be associated with both meningitis and/or pneumocephalus. Therefore, early active intervention is recommended with surgical exploration, lumbar subarachnoid drain, and less commonly epidural blood patch. In the absence of a ligamentum flavum, the use of high-resolution ultrasound (US) spine imaging enables real-time advancement of a Tuohy needle towards the dura and the precise injection of blood to cover the dural defect.

Sugammadex: a novel approach to reversal of neuromuscular blockade.

Sugammadex is the first in a new class of medications termed selective relaxant binding agents. This medication acts to encapsulate free circulating steroidal nondepolarizing neuromuscular blocking agents. The encapsulation of neuromuscular agents effectively decreases the amount of neuromuscular blocker interacting at the neuromuscular receptor.

Transesophageal echocardiography for detection of propagating, massive emboli during prosthetic hip fracture surgery.

Fat embolus has been known to occur during major orthopedic surgery. In many cases, fat embolus syndrome is a postoperative complication of long bone orthopedic surgery, particularly femoral fractures occurring after trauma. Changes in intraoperative cardiopulmonary function have been reported in a subset of these patients, and they are associated with the degree of embolization occurring with manipulation or cementing of prostheses in the fractured femur.

Fat emboli in total knee arthroplasty: a prospective randomized study of computer-assisted navigation vs standard surgical technique.

A prospective exploratory study of fat emboli in patients undergoing total knee arthroplasty was performed in patients randomly assigned to surgery with computer-assisted navigation or standard technique. Transesophageal echocardiography of the right atrium was recorded for 5 consecutive 1-minute intervals after tourniquet deflation. Emboli were graded on a scale of 0 to 3 based on embolism size, amount of atrium filled, and duration of embolic shower, creating an overall score of 0 to 9.

Cerebral physiology of cardiac surgical patients treated with the perfluorocarbon emulsion, AF0144.

Background: Perfluorooctyl bromide is a biologically inert compound with short biologic retention and high oxygen solubility. The purpose of this study was to assess the effect of the perfluorocarbon emulsion, AF0144 (Perflubron, Alliance Pharmaceutical Corp, San Diego, CA), used in conjunction with acute normovolemic hemodilution on cerebral blood flow and cerebral emboli measurements during coronary artery bypass grafting with cardiopulmonary bypass.

Methods: Thirty-six adult cardiac surgical patients were enrolled in a single-institution, randomized, controlled, single-blind dose escalation trial.

Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities.

Objective: To determine the effects of positive-pressure ventilation and experimentally induced pericardial effusion and tamponade on transmitral flow velocities in dogs.

Design: Descriptive.

Setting: University laboratory.

Perflubron emulsion (AF0144) augments harvesting of autologous blood: a phase II study in cardiac surgery.

Objective: To assess tolerance and preliminary efficacy of a perfluorocarbon emulsion (AF0144) used with acute normovolemic hemodilution to reduce allogeneic blood transfusion for patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB).

Design: Controlled, single-blind, parallel-group phase II dose escalation trial.

Setting: Single-institution university medical center.

Esmolol improves left ventricular function via enhanced beta-adrenergic receptor signaling in a canine model of coronary revascularization.

Background: Recent American Heart Association guidelines highlight the paucity of data on effectiveness and/or mechanisms underlying use of beta-adrenergic receptor (beta AR) antagonists after acute coronary syndromes in patients subsequently undergoing revascularization. It is important to assess whether beta AR antagonists might protect the heart and improve ventricular function in this scenario. The authors therefore used esmolol (an ultra-short-acting beta AR antagonist) to determine whether beta AR antagonist treatment improves left ventricular function in a canine model of acute reversible coronary ischemia followed by coronary reperfusion during cardiopulmonary bypass (CPB).