Evaluation of Cardiac Function in Patients with Supratentorial Tumors and Raised Intracranial Pressure: HABIT-ICP, a Prospective Observational Study Using Transthoracic Echocardiography.

 An acute increase in intracranial pressure (ICP) has been shown to affect cardiac function due to brain ischemia and the associated increased sympathetic activity. However, there is limited literature on the changes in cardiac function in clinical scenarios where there is a gradual and progressive increase in ICP, such as in brain tumors. We aimed to assess and compare the cardiac function in patients with primary supratentorial brain tumors presenting with and without raised ICP for neurosurgery.

A prospective observational study to compare and evaluate delta down, aortic velocity time integral variability, and superior vena cava collapsibility index as predictors of fluid responsiveness in patients with supratentorial brain tumors undergoing elective neurosurgery.

Background: Patients undergoing surgical resection of brain tumors frequently exhibit a spectrum of hemodynamic fluctuations necessitating careful fluid management. This study aimed to evaluate the feasibility of dynamic predictors of fluid responsiveness, such as delta down (DD), aortic velocity time integral variability (VTIAoV), and superior vena cava collapsibility index (SVCCI), in patients undergoing neurosurgery for brain tumors.

Methods: In this prospective study, 30 patients scheduled to undergo elective neurosurgery for brain tumor resection were enrolled.

Role of Multimodal Monitoring in the Management of Massive Blood Transfusion in Pediatric Patients Undergoing Excision of Choroid Plexus Carcinoma - A Case-Based Review of a Novel Perioperative Protocol.

Choroid plexus carcinomas (CPCs) are rare intraventricular lesions encountered in the pediatric population. The dreaded perioperative complication causing high mortality and morbidity in patients undergoing excision of CPC is massive intraoperative hemorrhage, which results in massive blood transfusion, and coagulopathy. Hence, the main crux of perioperative management is to tackle intraoperative hemorrhage and coagulopathy by instituting goal-directed blood transfusion guided by multimodality monitoring.

Periprocedural management of patients presenting for neurointerventional procedures using flow diverters for complex intracranial aneurysms: An anesthetist's perspective - A narrative review.

Complex intracranial aneurysms pose significant challenges in the realm of neurointervention, necessitating meticulous planning and execution. This article highlights the crucial roles played by anesthetists in these procedures, including patient assessment, anesthesia planning, and continuous monitoring and maintaining hemodynamic stability, which are pivotal in optimizing patient safety. Understanding these complex procedures and their complications will aid the anesthetist in delivering optimal care and in foreseeing and managing the potential associated complications.

Evaluation of Cerebral Perfusion Pressure, Cerebral Blood Flow, and Cerebral Oxygenation at Different Head of Bed Positions Using Transcranial Doppler and Near-Infrared Spectroscopy in Postoperative Neurosurgical Patients.

Objectives: Nursing postoperative neurosurgical patients with head of bed (HOB) elevation beyond 30° might be desired at times to prevent pulmonary complications. Due to the paucity of studies determining the effect of HOB beyond 30° on cerebral perfusion pressure (CPP), cerebral blood flow (CBF), and regional cerebral oxygenation (rSO2), this study was designed.

Methods: A total of 40 patients following elective neurosurgery for supratentorial tumors were studied in the neurosurgical intensive care unit three hours following admission.

Evaluation of markers of cerebral oxygenation and metabolism in patients undergoing clipping of cerebral aneurysm under total intravenous anesthesia versus inhalational anesthesia: A prospective randomized trial (COM-IVIN trial).

Introduction: Anesthetic goals in patients undergoing clipping of cerebral aneurysm include maintenance of cerebral blood flow, oxygenation, and metabolism to avoid cerebral ischemia and maintenance of hemodynamic stability. We intend to study the influence of anesthetic agents on the outcome of aneurysmal subarachnoid hemorrhage (SAH).

Materials And Methods: This is a prospective, randomized, parallel, single-center pilot trial approved by the Institutional Ethics Committee and is prospectively registered with the Clinical Trial Registry of India.

A prospective-randomized placebo-controlled trial comparing the effects of nebulized dexmedetomidine v/s dexmedetomidine-lignocaine mixture on intraoperative hemodynamics and surgical field quality in patients undergoing endoscopic transnasal transsphenoidal pituitary tumor surgery.

Background: During transnasal transsphenoidal pituitary surgery (TNTSS), the primary objective is to maintain stable hemodynamics while ensuring ideal surgical conditions. This study aimed to investigate the effect of nebulized dexmedetomidine on hemodynamic parameters and the quality of the surgical field during TNTSS.

Methods: Seventy-five patients scheduled for TNTSS were randomized into three groups of 25 each and received preoperative nebulization with 5 mL of nebulizing fluid consisting of 1.

Use of near infrared spectroscopy for the prediction of perioperative complications in patients undergoing elective microsurgical resection of cerebral arteriovenous malformations- a prospective observational trial (NIRSCAM trial).

Purpose: Cerebral arteriovenous malformations (AVM) represent focal abnormal areas of low resistance circulation which render the peri-nidal neuronal tissue susceptible to ischemia. The post-excision cerebral perfusion surge can result in hyperaemic complications.We hypothesised that Near Infrared Spectroscopy (NIRS)-guided perioperative management can aid in the prediction and prevention of perioperative complications in patients presenting for surgical excision of cerebral AVMs.

Role of multimodal monitoring in the management of patients undergoing complex intracranial bypass procedures - A case series and literature review.

Patients undergoing complex intracranial neurovascular procedures continue to have a high mortality rate. Individualised goal-directed cerebral resuscitation employing multimodality neuromonitoring may impact these patients' treatment and prognosis. Advanced monitoring methods aid in the early identification of secondary brain insults and serve as endpoints for goal-directed therapy in the perioperative period.

Autologous versus allogeneic blood transfusion: A comparative study of the peri-operative outcomes in a tertiary care hospital in South India amidst the COVID-19 pandemic.

Autologous blood transfusion is known to have advantages over allogeneic transfusion. The COVID-19 pandemic intensified the already existing shortage of allogeneic blood supply. We carried out a study during this period with the aim to elicit the effects of autologous blood collection and transfusion, to compare the peri-operative outcomes of autologous and allogeneic transfusion practices and also to assess the influence of the autologous transfusion programme in the Blood Centre inventory.

Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors.

Objectives: A wide variety of electrocardiographic (ECG) changes has been described in the context of neurological catastrophe. There has been diverse and plentiful literature emphasizing the cardiac changes in acute cerebrovascular events and traumatic brain injury. In stark contrast, there is scarce literature on the incidence of cardiac dysfunction caused by raised intracranial pressure (ICP) resulting from brain tumors.

Effect of Different Surgical Positions on the Changes in Cerebral Venous Drainage in Patients Undergoing Neurosurgery: A Prospective Observational Study.

Background: Some patient positions employed to facilitate neurosurgery can compromise cerebral venous drainage and lead to increased intracranial pressure, intraoperative bleeding, and brain bulge. This study evaluated the impact of different surgical positions on internal jugular vein (IJV) flow as a measure of cerebral venous drainage and on optic nerve sheath diameter (ONSD) as an indirect assessment of intracranial pressure.

Methods: Ninety patients scheduled for elective primary brain tumor resection surgery were included in 3 groups of 30 each according to the surgical position: supine, prone, or lateral.

Near-Infrared Spectroscopy-Guided Hyperventilation for Transient Intracranial Pressure Control during Anesthesia Induction in a Patient with Impending Uncal Herniation.

Near-infrared spectroscopy (NIRS) is known to determine the adequacy of regional cerebral oxygen supply. NIRS values during anesthetic induction depends upon various factors such as anesthetic agents, inspired oxygen fraction, blood carbon dioxide levels and systemic blood pressure. Also high intracranial pressure (ICP) can lead to reduced NIRS values, secondary to increased cerebral vascular resistance induced decrease in cerebral blood flow.

Anesthetic Management of a Patient With Arterial Tortuosity Syndrome Undergoing Cerebral Revascularization Surgery-A Case Report.

Arterial tortuosity syndrome is a rare hereditary autosomal recessive connective tissue disorder characterized by elongation and tortuosity of the large- and medium-sized arteries. We present the case of a 13-year old child with arterial tortuosity syndrome who underwent occipital encephaloduroarteriomyosynangiosis for posterior circulation insufficiency. The constellation of clinical features in our patient portended significant anesthetic concerns, including difficult airway due to craniofacial abnormalities, risk of stroke, and myocardial infarction due to intracerebral and coronary arterial tortuosity and stenosis.

Anesthetic Management of Hashimoto's Encephalopathy Presenting for Spine Surgery.

Hashimoto's encephalopathy (HE) is a rare neuroendocrine disorder, and there are no reports regarding anesthetic implications in a patient diagnosed with HE. These patients can have a plethora of systemic manifestations involving cardiovascular, respiratory, renal, gastrointestinal, hematologic, and central nervous systems. Once diagnosed, meticulous preoperative assessment is essential to rule out systemic involvement and to reduce the perioperative morbidity.

A Comparative Study to Evaluate the Efficacy of Virtual Versus Direct Airway Assessment in the Preoperative Period in Patients Presenting for Neurosurgery: A Quest for Safer Preoperative Practice in Neuroanesthesia in the Backdrop of the COVID-19 Pandemic!

 Neurosurgical patients with cervical spine pathologies, craniofacial and craniovertebral junction anomalies, recurrent cervical spine, and posterior fossa surgeries frequently present with an airway that is anticipated to be difficult. Although the routine physical evaluation is nonaerosol-generating, Mallampati scoring, mouth opening, and assessment of lower cranial nerve function could potentially generate aerosols, imposing a greater risk of acquiring severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. Moreover, airway evaluation requires the patient to remove the mask, thereby posing a greater risk to the assessing anesthesiologist.