Hypotension prediction index for minimising intraoperative hypotension: A systematic review and meta-analysis of randomised controlled trials.

Background And Aims: Reports on the utility of the hypotension prediction index (HPI) in reducing the occurrence of intraoperative hypotension are conflicting. Therefore, the aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the overall effect of using HPI on intraoperative hypotension outcomes of time-weighted average (TWA), area under the hypotension threshold (AUHT), incidence and duration of hypotension.

Methods: We searched the electronic databases of PubMed, ProQuest and Scopus from inception till 30 October 2023.

Hippocampal volume and recovery profile following propofol sedation in children undergoing magnetic resonance imaging: An exploratory study.

Background: Reduction in the hippocampal volume may contribute to agitated and delayed emergence after anesthesia in epilepsy surgery. We hypothesized that hippocampal volume and the duration of various recovery parameters after a short duration of sedation may be correlated. The primary objective was to evaluate the correlation between hippocampal volumes with time to recovery after the stoppage of propofol infusion.

Transcranial ultrasonographic evaluation of effect of ventriculoperitoneal shunt on intracranial dynamics: A prospective observational study.

Background: Transcranial sonographic (TCS) evaluation of optic nerve sheath diameter (ONSD), third ventricular diameter (TVD) and mean flow velocities (Vm) and pulsatility index (PI) of middle cerebral artery (MCA) can provide important insights to the change in intracranial dynamics following ventriculo-peritoneal (VP) shunt surgery. The primary objective of this study was to observe changes in ONSD values following VP shunt at 12 h, compared to pre-VP shunt values.

Methods: After obtaining ethical approval, patients admitted with a diagnosis of hydrocephalus posted for a VP shunt surgery were prospectively enrolled.

Normalization of low frontal regional cerebral oxygenation after evacuation of chronic subdural hematoma in a patient with bilateral internal carotid artery stenosis.

Near infrared spectroscopy (NIRS) technology is frequently used to measure regional cerebral tissue oxygen saturation (rSO). The measurement of rSO has diverse range of clinical application for its easy bed-side applicability, continuous monitoring, interpretation and valuable information on cerebral oxygenation. However, it also has few technical limitations; absorption by skull tissues, presence of hematomas, and other pigments such as melanin, bilirubin can affect the rSO measurements and thus interfere with the accuracy of monitoring.

Neurogenic stunned myocardium resulting from surgical brainstem handling during resection of paediatric recurrent medulloblastoma-a possible brain heart interaction.

Background: Neurogenic stunned myocardium (NSM) is characterised by an acute onset cardiac dysfunction following an acute neurological insult which mimics acute coronary syndrome.

Case Details: A 12-year-old male child was admitted to the neuro-intensive care unit (NICU) following midline suboccipital craniotomy and resection of recurrent medulloblastoma. Postoperatively, in NICU, he developed tachycardia and hypotension, which was unresponsive to fluid challenge requiring norepinephrine infusion.

An investigation to the prolonged requirement (>7 days) of vasopressors in cervical spinal cord injury patients-a retrospective analysis.

Study Design: Retrospective chart review.

Objectives: The primary aim was to identify the number of patients requiring vasopressors beyond the first week of cervical spinal cord injury (SCI). Secondary objectives were to note the type, duration and doses of vasopressors and any association between prolonged vasopressors use and outcome.

Perioperative Management of a Child with Klippel-Feil Syndrome and Severe Uncorrected Aortic Stenosis Undergoing Cervical Spine Stabilization.

Severe stenotic aortic valve poses serious anesthetic challenges because of the fixed cardiac output and complex hemodynamics. The challenges magnify in the presence of a difficult airway which not only puts the airway at risk but also disturbs the hemodynamics, which can negatively impact the patient outcome. Moreover, prone positioning, intraoperative hemodynamics, recovery, and extubation are equally challenging for management.

Effect of magnesium and lignocaine on post-craniotomy pain: A comparative, randomized, double blind, placebo-controlled study.

Background: Lignocaine and Magnesium have an analgesic action and reduce perioperative opioid requirements. We carried out this study to evaluate the effect of magnesium and lignocaine on postoperative pain as assessed using the visual analog scale (VAS) and fentanyl consumption. We also measured S-100 B levels and noted the side effect of drugs if any.

Comparison of Full Outline of UnResponsiveness (FOUR) score and the conventional scores in predicting outcome in aneurysmal subarachnoid haemorrhage patients.

Background And Aims: Full Outline of UnResponsiveness (FOUR) score is a more comprehensive score used to assess eye response, motor response, brainstem reflexes, and respiration that was introduced to overcome the drawbacks of Glasgow coma scale (GCS) score. Our aim was to assess which score best predicts mortality and poor outcome in aneurysmal subarachnoid haemorrhage (aSAH) patients.

Methods: This cohort study, prospectively evaluated the use of FOUR score to assess the mortality and outcome in aSAH patients during the period from November 2015 to November 2016.

Intractable brain swelling during cerebral arteriovenous malformation surgery due to contralateral acute subdural haematoma.

Severe brain swelling during routine neurosurgery can herald serious consequences. Failure to control brain swelling despite adequate measures warns of a surgical cause and should be dealt efficiently. We report a case of an adult female who developed intraoperative acute subdural haematoma (SDH) and consequent intractable brain swelling during surgery of supratentorial arteriovenous malformation (AVM).

Effect of nitrous oxide on bispectral index values at equi-minimum alveolar concentrations of sevoflurane and desflurane.

Background And Aims: Bispectral index (BIS) values may be anaesthetic agent-specific, depending on their ability to suppress the electroencephalogram (EEG) signals. We carried out a prospective, randomised clinical trial to study the effect of nitrous oxide (NO) on the BIS values at an equi-minimum alveolar concentration (MAC) of sevoflurane and desflurane.

Methods: Sixty adult patients undergoing spine surgery were randomised into two groups; Group S (sevoflurane; = 30) and Group D (desflurane; = 30) for the maintenance of anaesthesia in oxygen and air or oxygen and NO mixture (FiO-0.

Reversal agents in anaesthesia and critical care.

Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist. Reversal agents are defined as any drug used to reverse the effects of anaesthetics, narcotics or potentially toxic agents. The controversy on the routine reversal of neuromuscular blockade still exists.