Two-year experience of multi-disciplinary team (MDT) outcomes for brain metastases in a tertiary neuro-oncology centre.

Brain metastases (BMs) are the most common intracranial tumour in adults and form a significant proportion of the neuro-oncology workload. Their management has progressed significantly in the last few decades but a gold-standard evidence-based management strategy has not been defined to date and several guidelines based on available evidence exist to support clinical decision-making. This paper evaluates the decision-making process of the neuro-oncology multi-disciplinary team (MDT) in a tertiary neuro-oncology centre over a two-year period.

Electroencephalographic variation during end maintenance and emergence from surgical anesthesia.

The re-establishment of conscious awareness after discontinuing general anesthesia has often been assumed to be the inverse of loss of consciousness. This is despite the obvious asymmetry in the initiation and termination of natural sleep. In order to characterize the restoration of consciousness after surgery, we recorded frontal electroencephalograph (EEG) from 100 patients in the operating room during maintenance and emergence from general anesthesia.

The association between intraoperative electroencephalogram-based measures and pain severity in the post-anaesthesia care unit.

This observational study aimed to identify simple electroencephalogram indices of inadequate intraoperative opioid-mediated nociceptive blockade and to compare these indices with routinely used clinical predictors of severe postoperative pain in adults. Intraoperative trend and waveform data (electrocardiogram, pulse oximetry and electroencephalogram) were collected, pain intensity in the post-anaesthesia care unit was quantified using an 11-point Verbal Rating Score, and opioid administration was recorded. Using the initial post-anaesthesia care unit Verbal Rating Score as the primary endpoint, the relationship between five possible explanatory variables--surgery type, depth of volatile anaesthesia (minimum alveolar concentration), electroencephalogram signs (state entropy, spindle-like activity and delta-band power) and estimated end-of-operation effect-site morphine concentrations--was examined.