Intracranial Pressure Monitoring Location: A Pilot Study on the Validation of Subdural Site with the Intraventricular Site.

 Knowledge of preoperative and intraoperative intracranial pressure (ICP) enables the neuroanesthesiologist to optimize cerebral perfusion pressure. However, ICP is rarely monitored during the intraoperative period. In this report, subdural site ICP measurement is validated with intraventricular ICP measurement, and the feasibility of subdural ICP monitoring during the intraoperative period is discussed.

Carbon dioxide induced cerebral vasomotor reactivity in moderate-to-severe cerebral venous thrombosis patients and its impact on prognosis: A transcranial doppler-based prospective exploratory study.

Hyperventilation-induced intracranial pressure reduction might be impaired in cerebral venous thrombosis (CVT) patients. Using transcranial Doppler, we assessed carbon dioxide-vasomotor reactivity (CO-VMR) within 24 hours of admission in CVT patients and studied its correlation with patient outcomes. Adult moderate-severe CVT patients (participants of another large observational study) were included.

Comparison of hands-free Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) with conventional facemask ventilation technique for oxygenation in patients undergoing electroconvulsive therapy - A cross over study.

Objectives: Modified ECT is routinely conducted using face mask (FM) and bag ventilation technique. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a novel hands-free insufflation technique that provides oxygenation and prolongs apnoea time. There is limited literature comparing the two techniques.

Does Propofol Effect Site (Brain) Concentration Predicted by Target-Controlled Infusion Correlate with Propofol Measured in the Brain? An Exploratory Study in Neurosurgical Patients.

Background: Total intravenous anesthesia with propofol can be administered by target-controlled infusion pumps, which work on the principles of pharmacokinetic modeling. While designing this model, neurosurgical patients were excluded as the surgical site and drug action site remained the same (brain). Whether the predicted set propofol concentration and the actual brain site concentration correlate, especially in neurosurgical patients with impaired blood-brain barrier (BBB), is still unknown.

Clinical Scoring and Ultrasound-Based Diaphragm Assessment in Predicting Extubation Failure in Neurointensive Care Unit: A Single-Center Observational Study.

Background: Patients in the neurointensive care unit (NICU) fail extubation despite successful weaning from mechanical ventilation. Parameters currently used in the general intensive care unit do not accurately predict extubation success in the NICU. In this study, peak cough expiratory flow rate, ultrasound-based diaphragm function assessment, and comprehensive clinical scoring systems were measured to determine whether these new variables, in isolation or combination, could predict extubation failure successfully in the NICU.

Superselective Anesthesia Functional Examination of the Diaphragm during Endovascular Embolization of Spinal Cord Arteriovenous Malformation.

Superselective anesthesia functional evaluation (SAFE) is an adjunct to the Wada test. It is performed to rule out unintentional positioning of the tip of the embolization catheter proximal to the origin of a normal artery supplying eloquent region of spinal cord. We report a case of a 36-year-old male with cervical intramedullary spinal cord arteriovenous malformation (SCAVM) at C3 level.

Feasibility of THRIVE oxygenation and intra-operative lung-protective ventilation in morbidly obese patients undergoing neurosurgical procedures.

The conduct of anesthesia in morbidly obese patients undergoing neurosurgical procedures can be challenging considering the multi-system organ involvement. Implementation of conventional lung-protective ventilation in morbidly obese patients can have a negative impact on the intra-cranial dynamics. We report a series of three patients with morbid obesity and a difficult airway for the neurosurgical procedure.

Role of Nimodipine and Milrinone in Delayed Cerebral Ischemia.

Objective: The role of nimodipine and milrinone in the management of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) was studied using clinical and TCD (transcranial Doppler) parameters.

Methods: In this prospective observational study, patients with DCI after aneurysmal SAH presenting between November 2020 and June 2021 who were treated by either intra-arterial nimodipine (IAN) or intravenous milrinone (IVM) were included after excluding patients in whom both IAN and IVM had been given or mechanical angioplasty was performed. Twelve-hourly TCD was performed during the course of the therapy.

Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report.

Background: Methotrexate is an antimetabolite drug that blocks dihydrofolate reductase and impairs cellular DNA synthesis. Administration of intravenous iodinated radiocontrast agents can cause life-threatening toxicity in patients receiving methotrexate.

Case: A 60-year-old female patient with rheumatoid arthritis underwent a craniotomy and clipping of a distal anterior cerebral artery aneurysm.

Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) ventilation during electroconvulsive therapy (ECT) for a pregnant patient- A novel technique.

Maintaining oxygenation and ventilation is imperative in a pregnant patient undergoing electroconvulsive therapy (ECT). Here, we present the successful utilization of Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) in a six-month pregnant patient who received ECT under general anesthesia.

A prospective observational study of electrocardiographic and echocardiographic changes in traumatic brain injury - effect of surgical decompression.

Background: Traumatic brain injury (TBI) causes significant changes in myocardial function, which is represented by ECG and echocardiographic changes. We intended to study the effect of surgical decompression on these changes.

Materials And Methods: We recruited adult TBI patients undergoing surgery within 48 h of injury.

Postoperative Outcomes Following Elective Surgery in India.

Introduction: The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis.

Diaphragm Function Assessment During Spontaneous Breathing Trial in Patients with Neuromuscular Diseases.

Introduction: The optimal time to discontinue patients from mechanical ventilation is critical as premature discontinuation as well as delayed weaning can result in complications. The literature on diaphragm function assessment during the weaning process in the intriguing subpopulation of critically ill neuromuscular disease patients is lacking.

Methods: Patients with neuromuscular diseases, on mechanical ventilation for more than 7 days, and who were ready for weaning were studied.

Hemodynamic Changes During Surgical Decompression in Traumatic Brain Injury Patients.

Objective: To understand the hemodynamic changes that occur with surgical decompression of lesions caused by traumatic brain injury.

Methods: In this prospective, observational study, patients with traumatic brain injury requiring craniotomy within 48 hours of injury were recruited. Cardiac index (CI), stroke volume index, stroke volume variation, systemic vascular resistance index (SVRI), heart rate, and mean arterial pressure were monitored throughout surgery using a FloTrac transducer.

Incidence of Deep Vein Thrombosis in Neurointensive Care Unit Patients-Does Prophylaxis Modality Make Any Difference?

Background And Aims: To determine the incidence of upper and lower limb deep vein thrombosis (DVT) using ultrasonography (USG) in adult patients admitted to neuro-medical and neurosurgical intensive care unit (ICU).

Materials And Methods: In this prospective observational study, patients admitted to the medical and surgical neuro-ICU and remained in the ICU for more than 48 hours were recruited. All patients were clinically examined for DVT.

Haemodynamic changes during prone positioning in anaesthetised chronic cervical myelopathy patients.

Background And Aims: Anaesthetised patients, when positioned prone, experience hypotension and reduction in cardiac output. Associated autonomic dysfunction in cervical myelopathy patients predisposes them to haemodynamic changes. The combined effect of prone positioning and autonomic dysfunction in anaesthetised patients remains unknown.

Correlation between time lag of arterial-plethysmographic waveforms and systemic vascular resistance: a prospective study.

Blood pressure (BP), a surrogate of cardiac output (CO), is also dependent on systemic vascular resistance (SVR). But SVR is not routinely monitored in daily clinical practice. We hypothesise that the time difference between the peripheral arterial waveform and the finger plethysmographic waveform (time lag index - TLi) could indicate the systemic vascular resistance.

Hydroxyethyl starch and kidney function: A retrospective study in patients undergoing therapeutic plasma exchange.

Purpose: Hydroxyethyl starch (HES) and albumin are used as replacement fluids during therapeutic plasma exchange (TPE). HES solutions are no longer recommended in critically ill patients due to its effect on kidneys and coagulation. In this retrospective study, we tried to look at the association between cumulative HES administration and kidney function in patients undergoing TPE.

Effect of Hyperoxia on Cerebral Blood Flow Velocity and Regional Oxygen Saturation in Patients Operated on for Severe Traumatic Brain Injury-The Influence of Cerebral Blood Flow Autoregulation.

Background: The effect of normobaric hyperoxia on brain oxygenation in the presence or absence of intact autoregulation has not been studied previously in acute traumatic brain injury (TBI).

Methods: In this prospective clinical investigation of 50 patients operated on for severe TBI, cerebral blood flow (CBF) velocity in the middle cerebral artery was measured using transcranial Doppler. Regional cerebral oxygen saturation using near-infrared spectroscopy at 3 different fractions of inspired oxygen (Fio) (0.

Volatile anesthetic for the control of posthypoxic refractory myoclonic status.

Posthypoxic myoclonus (Lance-Adams syndrome) is characterized by myoclonus involving multiple muscle groups which is resistant to most conventional antiepileptic drugs. We present a case of hypoxic brain injury-induced myoclonic status epilepticus successfully controlled with isoflurane. The antimyoclonic effects of isoflurane are likely due to potentiation of inhibitory postsynaptic GABAA receptor-mediated currents and its effects on thalamocortical pathways.

Cerebral vasospasm: current understanding.

Purpose Of Review: With recent research trying to explore the pathophysiologic mechanisms behind vasospasm, newer pharmacological and nonpharmacological treatments are being targeted at various pathways involved. This review is aimed at understanding the mechanisms and current and future therapies available to treat vasospasm.

Recent Findings: Computed tomography perfusion is a useful alternative tool to digital subtraction angiography to diagnose vasospasm.

Anesthetic management for foramen magnum decompression in a patient with Morquio syndrome: a case report.

Morquio syndrome is a hereditary mucopolysaccharide disorder presenting with an abnormality of the craniocervical junction from childhood. We describe an adult patient who presented with Morquio syndrome who had subglottic narrowing of the airway, restrictive pulmonary disease, and mild mitral regurgitation and trivial aortic regurgitation. The anesthetic management of this patient for atlantoaxial stabilization is presented.