Practice Changing Articles in Neuroanesthesiology and Neurocritical Care in Recent Years: A Literature Review.

Background: Neuroanesthesiology and neurocritical care are constantly evolving branches of clinical neuroscience, and patient management is often influenced by literature such as randomized controlled trials, systematic reviews, and meta-analyses. Many controversies still exist in the management of neurologically injured patients, and most research in this field does not translate into significant changes in clinical practice.

Objective: This review aims to discuss studies of clinical importance published in preeminent journals over the time period 2017-2020, which may have the potential to influence our current management protocols.

A Case Report of Paravertebral Block: A Safe Alternative for Microdiscectomy in a Pregnant Patient.

Nonobstetric surgery during pregnancy is common. Administration of safe anesthesia to a pregnant patient, while minimizing its side effects on the fetus, is a major challenge for the anesthesiologist. Both general anesthesia and central neuraxial block are associated with risks during early pregnancy.

Management of traumatic brain injury patients.

Traumatic brain injury (TBI) has been called the 'silent epidemic' of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Foundation.

Comparison of 20% mannitol and 3% hypertonic saline on intracranial pressure and systemic hemodynamics.

Mannitol and hypertonic saline (HS) are most commonly used hyperosmotic agents for intraoperative brain relaxation. We compared the changes in ICP and systemic hemodynamics after infusion of equiosmolar solutions of both agents in patients undergoing craniotomy for supratentorial tumors. Forty enrolled adults underwent a standard anesthetic induction.

Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge.

Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

Perioperative problems in patients with brainstem tumors and their influence on patient outcome.

Background And Aims: Patients with brainstem tumors have many associated systemic abnormalities and are prone to develop perioperative complications. We studied the problems associated with brainstem tumors and their influence on the postoperative neurological outcome.

Material And Methods: Retrospective review of records of patients who underwent surgery for brainstem tumors over a period of 8 years was done.

Anaesthesia for awake craniotomy: A retrospective study of 54 cases.

Background And Aims: The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respiratory and haemodynamic stability in an awake patient who should be able to co-operate during intraoperative neurological assessment. The current literature, sharing the experience on awake craniotomy, in Indian context, is minimal. Hence, we carried out a retrospective study with the aim to review and analyse the anaesthetic management and perioperative complications in patients undergoing awake craniotomy, at our centre.

Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy.

Background: Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane.

Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study.

Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies.

Materials And Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay) in patients undergoing transsphenoidal removal of pituitary tumors.

Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery.

Background: Cognitive dysfunction after subarachnoid hemorrhage (SAH) has been attributable to presence of subarachnoid blood, hydrocephalus (HCP), cerebral edema, vasospasm, and temporary clipping of intracranial aneurysm. Provision of neuroprotection during temporary clipping may improve postoperative cognition in such patients.

Materials And Methods: Good-grade aneurysmal SAH patients undergoing temporary clipping during surgery were allocated either to group C (control) or group P (propofol).

Procedural sedation and analgesia in pediatric patients.

A spectrum of conditions requires sedation and analgesia in pediatric population. Ineffective treatment of pain may result in physiological and behavioral responses that can adversely affect the developing nociceptive system. The recognition of pain in children can be facilitated by different pain scales.

Specific intensive care management of patients with traumatic brain injury: Present and future.

Traumatic brain injury (TBI) is a major global problem and affects approximately 10 million peoples annually; therefore has a substantial impact on the health-care system throughout the world. In this article, we have summarized various aspects of specific intensive care management in patients with TBI including the emerging evidence mainly after the Brain Trauma Foundation (BTF) 2007 and also highlighted the scope of the future therapies. This review has involved the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic.

General intensive care for patients with traumatic brain injury: An update.

Background: Traumatic brain injury (TBI) is a growing epidemic throughout the world and may present as major global burden in 2020. Some intensive care units throughout the world still have no access to specialized monitoring methods, equipments and other technologies related to intensive care management of these patients; therefore, this review is meant for providing generalized supportive measurement to this subgroup of patients so that evidence based management could minimize or prevent the secondary brain injury.

Methods: Therefore, we have included the PubMed search for the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic.

Pre-hospital and initial management of head injury patients: An update.

Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006.

Early brain injury and subarachnoid hemorrhage: Where are we at present?

The current era has adopted many new innovations in nearly every aspect of management of subarachnoid hemorrhage (SAH); however, the neurological outcome has still not changed significantly. These major therapeutic advances mainly addressed the two most important sequels of the SAH-vasospasm and re-bleed. Thus, there is a possibility of some different pathophysiological mechanism that would be responsible for causing poor outcome in these patients.

Research studies that have influenced practice of neuroanesthesiology in recent years: A literature review.

Through evolving research, recent years have witnessed remarkable achievements in neuromonitoring and neuroanesthetic techniques, with a huge body of literature consisting of excellent studies in neuroanaesthesiology. However, little of this work appears to be directly important to clinical practice. Many controversies still exist in care of patients with neurologic injury.

A retrospective analysis of perioperative complications during intracranial neuroendoscopic procedures: our institutional experience.

Background: Neuroendoscopic procedures are now being performed more frequently, and with advancement in technology, complications related to the procedure and equipments have also minimized or changed. We report our experience with 223 patients who underwent intracranial neuroendoscopic procedures.

Materials And Methods: The rates of various perioperative complications, both surgical and anesthesia related, during intracranial neuroendoscopic surgeries were studied.

ST elevation--an indication of reversible neurogenic myocardial dysfunction in patients with head injury.

This report describes a patient who presented with signs of meningitis four days after head injury. The patient had ST elevation on electrocardiography along with hypotension and positive tropinin T test, mimicking inferior wall infarction. The ST changes resolved within 48 hours of intensive care management.

Effects of phenytoin therapy on bispectral index and haemodynamic changes following induction and tracheal intubation.

Laryngoscopy and tracheal intubation (LTI) increase blood pressure and heart rate (HR). Intensity of these changes is influenced by the anaesthetic depth assessed by the bispectral index (BIS). We determined the effect of phenytoin on anaesthetic depth and its influence on haemodynamics following LTI.

Hemodynamic and bispectral index changes following skull pin attachment with and without local anesthetic infiltration of the scalp.

We studied the hemodynamic and bispectral index (BIS) changes in 44 patients undergoing cervical diskectomy with attachment of a Gardner-Wells tong (with two sharp conical pins) to the skull to facilitate intraoperative bone graft insertion. Patients were induced with fentanyl, thiopentone, and rocuronium and maintained with 66% nitrous oxide and 0.5% isoflurane, Before insertion of the pins, patients were randomly allocated to have either saline or lidocaine infiltration of the scalp at the proposed pin sites.