Perioperative Glycemia Management in Patients Undergoing Craniotomy for Brain Tumor Resection: A Global Survey of Neuroanesthesiologists' Perceptions and Practices.

Objective: There is a paucity of clinical evidence that guides perioperative glycemia management in patients undergoing craniotomy for brain tumor resection. The purpose of this study was to better understand global perceptions and practices related to glycemia management in these patients.

Methods: Neuroanesthesiologists throughout North America, South America, Europe, and Asia filled out a brief online questionnaire related to their perceptions and practices regarding glycemia management in patients undergoing craniotomy for brain tumor resection.

Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review, development and validation.

Background: Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04-1.

[Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis].

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

[Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment].

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis.

Analysis of the hemostatic therapy in liver transplantation guided by rotational thromboelastometry or conventional laboratory tests.

Background: Coagulopathy is quite common in chronic liver disease patients undergoing orthotopic liver transplantation (OLT). Diagnosis of intraoperative bleeding disorders is based on conventional laboratory tests (CLTs), and thus, the patients are frequently exposed to unnecessary transfusions of blood products. The present study aimed to analyze the intraoperative administration of blood products in patients undergoing OLT, using rotational thromboelastometry (ROTEM) or CLTs.

[Efficacy and safety of antifibrinolytics in oncological surgery: a systematic review and meta-analysis].

Background And Objectives: The administration of antifibrinolytics has been shown to be effective in reducing blood loss and the need for transfusions in surgeries. However, few studies have evaluated these drugs in cancer surgery. The objective was to review the efficacy and safety of the treatment with antifibrinolytics in patients who underwent oncologic surgeries.

Intraoperative neurophysiological monitoring in neuroanesthesia.

Purpose Of Review: The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM).

Recent Findings: Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time. IONM is indicated in surgeries posing risk to targeted neural tissues and adjacent structures.

[Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report].

Introduction: Advanced hepatic disease may – in addition to the widely recognized hemorrhagic complications – occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (ROTEM).

Case Report: A 56 year-old male patient diagnosed with alcohol cirrhosis using warfarin (2.

Anesthetics, cerebral protection and preconditioning.

Background And Objectives: Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents.

Content: Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use.

Anesthetics, cerebral protection and preconditioning.

Background And Objectives: Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents.

Content: Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use.

Influence of total intravenous anesthesia, entropy and laparoscopy on oxidative stress.

Background And Objectives: Recent studies have correlated postoperative mortality with anesthetic mortality, especially with the depth of anesthesia and systolic blood pressure (SBP). The aim of this study is to evaluate the effects of the depth of total intravenous anesthesia (TIVA) using remifentanil and propofol, performed with monitoring of response entropy (RE) on blood concentrations of oxidative stress markers (TBARS and glutathione) during laparoscopic operations.

Method: Twenty adult patients, ASA I, BMI 20-26 kg.

Risk factor for intraoperative awareness.

Background And Objectives: The intraoperative awareness is an adverse event in the general anesthesia, and may occur in approximately 20,000 cases per year, which justifies the study of the risk factors for this event. The objective of this study was to review this subject in order to reduce the incidence of intraoperative awareness and psychological sequelae incurring from this incident, which may result in post-traumatic stress disorder with negative repercussions on the surgical patient social, psychic and functional development.

Content: It was conducted a review of the intraoperative awareness assessing its different phases during general anesthesia such as dreaming, wakefulness, explicit and implicit memory, as well as the analysis, consequences and prevention of its main related factors.

Bispectral index and other processed parameters of electroencephalogram: an update.

Background And Objectives: The processed analysis of electroencephalogram became extremely important to monitor nervous system, being used to obtain a better anesthetic adequacy. The objective was to conduct a review about each processed parameter, defining its real importance.

Content: A review was conducted showing mathematical, physical and clinical aspects as well as their correlations and updates, presenting new integrated parameters.

[Effects of sedation produced by the association of midazolam and ketamine s(+) on encephalographic variables].

Background And Objectives: Ketamine S(+) is important in pain modulation in surgical patients. The objective of the present study was to evaluate the relationship between the levels of sedation produced by low doses of ketamine S(+), as well as encephalographic variables: BIS, SEF 95%, pEMG, suppression rate, and presence of burst-suppression.

Methods: Thirty patients of both sexes, aged 25-50 years, were randomized into three groups.

[Spectral entropy: a new method for anesthetic adequacy.].

Background And Objectives: Though universally employed, clinical signs to evaluate anesthetic adequacy are not reliable. Over the past years several pieces of equipment have been devised to improve intraoperative handling of anesthetic drugs, some of them directly measuring cerebral cortical activity (hypnosis). None of them, however, has offered the possibility of directly evaluating sub-cortical activity (motor response).

[Entropy: a new method of measuring depth of anesthesia. Comparative study with bispectral index during clinical evaluation in tracheal intubation of patients anesthetized with sevoflurane.].

Background And Objectives: Spectral entropy, a new EEG analysis method based on the quantification of EEG chaos, was developed to monitor anesthetic depth. The spectral entropy involves two distinct types of analysis: state entropy (SE), which includes low frequency signals (< 32 Hz), and response entropy (RE), which includes signals up to 47 Hz. This study aimed at comparing entropy-derived values to BIS-derived values and sub-cortical (autonomic and somatic) responses recorded during tracheal intubation in patients submitted to general anesthesia with sevoflurane.

[Processed electroencephalogram in children anesthetized with sevoflurane. Is it feasible?].

Background And Objectives: EEG-derived bispectral index (BIS), has been indicated as a major substrate for measuring hypnotic effects of anesthetic drugs. However, there are only limited data on the use of EEG in anesthetized children. This study aimed at evaluating changes in BIS, SEF95%, relative delta band frequency amplitude (d%) and suppression rate (SR) in children, correlating these changes with sevoflurane pharmacodynamic variables (EC and EC/MAC) as compared to adults.

[Evaluation of electroencephalographic parameters during the administration of different nitrous oxide concentrations.].

Background And Objectives: Spectral electroencephalography has been used to measure anesthetic depth, hypnosis and sedation levels induced by different anesthetic agents. This study aimed at evaluating the effects of N2O on electroencephalographic (EEG) variables and sedation levels according to Observer Assessment of Alertness/Sedation (OAA/S) scale, as well as on hemodynamic and respiratory parameters.

Methods: Thirty adult patients from both genders, physical status ASA I, aged 20 and 40 years, were submitted to the following protocol: after 10 minutes of relaxation, spontaneously breathing with eyes close, patients were given 30% and 50% N2O concentrations under face mask.

Influence of dexmedetomidine upon sevoflurane end-expiratory concentration. Evaluation by bispectral index, suppression rate and electroencephalographic power spectral analysis.

Background And Objectives: Dexmedetomidine, an alpha2-adrenergic agonist, has been described as being able to decrease the demand for both venous and inhalational agents. This study aimed at evaluating the influence of Dexmedetomidine upon sevoflurane end-expiratory concentration (EC) with monitoring the depth of anesthesia.

Methods: Participated in this study 40 female adult patients, physical status ASA I, submitted to gynecological laparoscopy under general anesthesia maintained with sevoflurane, who were randomly divided in two groups: Group I (n=20), without dexmedetomidine; and Group II (n=20), with dexmedetomidine, in continuous infusion, as follows: Rapid phase (1 microg kg(-1) in 10 min(-1)) 10 minutes before anesthesia induction, followed by a maintenance phase (0.