Journal of neurosurgical anesthesiology

Publications in this journal

• Article: Nicorandil Protects Pial Arterioles From Endothelial Dysfunction Induced by Smoking in Rats.

  Kenji Iwata, Hiroki Iida, Mami Iida, Motoyasu Takenaka, Kumiko Tanabe, Naokazu Fukuoka, Masayoshi Uchida
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  ABSTRACT: BACKGROUND:: Our aims are to investigate the effect of nicorandil, which is used for angina prevention and treatment, on the endothelial dysfunction induced by acute smoking and to clarify the underlying mechanism. MATERIALS AND METHODS:: A closed cranial window preparation was used to measure changes in pial vessel diameters in Sprague-Dawley rats. The responses of arterioles were examined to an endothelium-dependent vasodilator acetylcholine (ACh) before smoking. After intravenous nicorandil (200 μg/kg bolus infusion and then 60 μg/kg/min continuous infusion; n=6) or saline (control; n=6) pretreatment, the pial vasodilator response to topical 10 M ACh infusion was reexamined both before and 1 hour after 1-minute cigarette smoking. Thereafter, either glibenclamide or N-ω-nitro-L-arginine methyl ester (L-NAME) was infused 20 minutes before nicorandil infusion. In the glibenclamide (n=6) or L-NAME; n=6 pretreatment group, the pial vasodilator response to topical ACh was examined before and after smoking. Percentage changes in pial vessel diameters were used for the statistical analysis. RESULTS:: Cerebral arterioles were dilated during topical ACh infusion. After smoking, 10 M ACh constricted cerebral arterioles (-7.7±1.8%). After smoking, in the nicorandil-pretreatment group, 10 M ACh dilated cerebral pial arterioles by 10.5±3.0%. When given before nicorandil infusion, glibenclamide, but not L-NAME, abolished the preventive effects of nicorandil against smoking-induced endothelial dysfunction in pial vessels. CONCLUSIONS:: Acute cigarette smoking causes dysfunction of endothelium-dependent pial vasodilatation, and nicorandil prevents this effect of smoking. The mechanism underlying this protective effect may depend mainly on adenosine triphosphate-sensitive potassium-channel activation.
  Journal of neurosurgical anesthesiology 05/2013;
• Article: Subarachnoid Anesthesia in a Patient With Lateral Ventricle Tumor.

  Indira Gurajala, Don J Palamattam, Ramachandran Gopinath
  Journal of neurosurgical anesthesiology 05/2013;
• Article: A Retrospective Analysis of Stridor After Vestibular Schwannoma Surgery.

  Appavoo Arulvelan, Parthasarathi Gayatri, Vimalakumari Smita, Suresh N Nair
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  ABSTRACT: BACKGROUND:: Transient lower cranial nerve deficits may occur after surgery in the posterior cranial fossa. Stridor has been reported after cerebellopontine angle epidermoid resection. The aim of this retrospective study is to find out whether any preoperative, intraoperative, and postoperative factors lead to stridor after resection of vestibular schwannoma. METHODS:: Data of patients who underwent vestibular schwannoma resection from 2006 to 2011 were collected. We collected the following factors-age, sex, weight, diabetes, hypertension, preoperative cranial nerve deficits, tumor characteristics, intraoperative use of nitrous oxide, difficult endotracheal intubation, duration of surgery, postoperative cough and swallowing difficulty, limb weakness, and facial edema. Data of patients who developed stridor were compared with those who did not develop stridor. Odds ratio (OR) was used to assess the risk of developing stridor with each factor. RESULTS:: Thirteen patients (4.65%) developed stridor in immediate postextubation period. The risk of stridor was significantly high in patients who had difficult intubation (OR=9.56), longer duration of surgery (P=0.034) and in patients who developed facial edema (OR=13.33), upperlimb weakness (OR=32.88), poor cough (OR=7.72), and swallowing difficulty (OR=24.97) in the postoperative period. CONCLUSIONS:: The identification of the exact etiology of stridor often is difficult. Our results suggest that stridor may be more likely in patients who were difficult to intubate, had longer duration of surgery, who develop facial and neck edema and upperlimb weakness, poor cough, and swallowing after surgery. Establishing airway patency with intubation of the trachea may be required if patients develop oxygen desaturation due to stridor.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Prevention and Treatment of Local Anesthetics-induced Complete Atrioventricular-Block during Awake Craniotomy.

  Federico Bilotta, Luca Titi, Giovanni Rosa
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Demented and Hearing Loss Patient.

  George Williams
  Journal of neurosurgical anesthesiology 04/2013;
• Article: The Effect of Gabapentin Premedication on Postoperative Nausea, Vomiting, and Pain in Patients on Preoperative Dexamethasone Undergoing Craniotomy for Intracranial Tumors.

  Satyajeet Misra, Gayatri Parthasarathi, George C Vilanilam
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  ABSTRACT: BACKGROUND:: In patients undergoing craniotomy, the incidence of postoperative nausea and vomiting (PONV) is 55% to 70% and that of moderate to severe postoperative pain is 60% to 84%. We hypothesized that gabapentin plus dexamethasone would be superior, compared with placebo and dexamethasone in reducing the incidences of PONV and pain after craniotomy. METHODS:: Patients undergoing craniotomy received either placebo (group D) or gabapentin (600 mg) (group GD) premedication orally, 2 hours before induction of anesthesia. In addition, all patients received 4 mg of intravenous dexamethasone on the morning of surgery and continued receiving it after every 8 hours. The 24-hour incidence of nausea, emesis, or PONV (nausea, emesis, or both) (primary outcome) and postoperative pain scores (secondary outcome) were analyzed with the χ test and the Wilcoxon rank-sum test as applicable. RESULTS:: A significant difference was observed between the groups in the incidence of nausea [odds ratio (OR), 0.23; 95% confidence interval (CI), 0.07, 0.80; P=0.02], PONV (OR, 0.3; 95% CI, 0.08, 0.8; P=0.02), and the requirement for antiemetics (OR, 0.30; 95% CI, 0.09, 0.9; P=0.03). The number of emetic episodes were also reduced in group GD, but this did not assume statistical significance (OR, 0.34; 95% CI, 0.10, 1.1; P=0.06). However, there was no significant difference in either the postoperative pain scores or the opioid consumption between the 2 groups. CONCLUSIONS:: A dosage of 600 mg of gabapentin plus 4 mg of dexamethasone significantly reduced the 24-hour incidence of nausea and PONV. However, there was no reduction in either the postoperative pain scores or opioid consumption.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: The Effect of Pumpless Extracorporeal CO2 Removal on Regional Perfusion of the Brain in Experimental Acute Lung Injury.

  Stefan Kreyer, Thomas Muders, Henning Luepschen, Corinna Kricklies, Katharina Linden, Martin Soehle, Joerg Zinserling, Christian Putensen, Hermann Wrigge
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  ABSTRACT: BACKGROUND:: Lung-protective mechanical ventilation with low tidal volumes (VT) is often associated with hypercapnia (HC), which may be unacceptable in patients with brain injury. CO2 removal using a percutaneous extracorporeal lung assist (pECLA) enables normocapnia despite low VT, but its effects on regional cerebral blood flow (rCBF) remain ambiguous. We hypothesized that reversal of HC by pECLA impairs rCBF in a porcine lung injury model. METHODS:: Lung injury was induced in 9 anesthetized pigs by hydrochloric acid aspiration. rCBF and systemic hemodynamics were measured by colored microsphere technique and transpulmonary-thermodilution during a randomized sequence of 4 experimental situations: pECLA shunt-on (1) with HC and (2) without HC, pECLA shunt-off (3) with HC and (4) without HC. RESULTS:: HC increased rCBF (P<0.05). CO2 removal with pECLA resulting in normocapnia, decreased rCBF to levels comparable to those without pECLA and normocapnia. HC resulted in increased cardiac output (+25.5%). Cardiac output was highest during HC with pECLA shunt (+44.9%). During pECLA with CO2 removal, cardiac output (+38.1%) decreased compared with pECLA without CO2 removal, but stayed higher than during normocapnia/no pECLA shunt (P<0.05). CONCLUSIONS:: In this animal model, mechanical ventilation with low VT was associated with HC and increased rCBF. CO2 removal by pECLA restored normocapnia, reduced rCBF to levels of normocapnia, but required a higher systemic blood flow for the perfusion of the pECLA device. If these results could be transferred to patients, extracorporeal CO2 removal might be an option for treatment of combined lung and brain injury in condition of a sufficient cardiac flow reserve.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Pulsed Radiofrequency for the Suprascapular Nerve for Patients With Chronic Headache.

  Shay Shabat, Josheph Leitner, Yoram Folman
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  ABSTRACT: BACKGROUND:: Chronic shoulder or suprascapular pain is a disabling phenomenon. Chronic headache is also a disabling phenomenon for many patients. Once it was believed that chronic headache that is attributed to the cervical spine originates from the upper cervical nerve roots (C0-C3). Currently, it is suggested by some authors that the reason for headache in many patients is attributed to the lower cervical nerve roots in the cervical spine. The suprascapular nerve originates from the C5 and C6 nerve roots and supplies the suprascapular and shoulder region. Pulsed radiofrequency (PRF) has gained popularity over recent years as a good clinical tool in treating patients with shoulder/suprascapular pain. It is usually considered as a treatment option after conservative treatment has failed. The purpose of this study was to evaluate whether PRF for the suprascapular nerve has also beneficial effect for patients that have also chronic headache that is attributed to the lower cervical nerve roots. MATERIALS AND METHODS:: Sixty-nine patients with a follow-up of 1 year who had chronic shoulder/suprascapular pain and chronic headache were examined after they underwent PRF procedures to the suprascapular nerve (either unilateral or bilateral). RESULTS:: Forty patients (58%) reported long-term pain relief (1-y follow-up) for the shoulder/suprascapular pain and 31 patients (45%) reported long-term pain relief for the headache. This pain relief was defined as reduction of Visual Analogue Score by at least 30%. No complications were found in this study except for mild discomfort in the treated area which spontaneously resolved up to 3 weeks after the procedure. CONCLUSIONS:: PRF for the suprascapular nerve is a safe and an effective procedure for patients who suffer from shoulder/suprascapular pain and also for headache that is attributed to the lower cervical nerve roots. It should be tried after conservative treatment has failed.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Awake Craniotomy for Brain Tumor Resection: The Rule Rather Than the Exception?

  Tyler Brown, Ashish H Shah, Amade Bregy, Nirav H Shah, Michael Thambuswamy, Eric Barbarite, Thomas Fuhrman, Ricardo J Komotar
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  ABSTRACT: OBJECTIVE:: Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA. METHODS:: A literature search was performed using the Medline and PubMed databases from 1970 and 2012 that compared craniotomy for tumor resection under GA and AC. Data of interest included length of hospital stay, operating time, extent of resection, and neurological sequelae. RESULTS:: A total of 8 studies with 951 patients (411 utilizing AC and 540 utilizing GA) were included in this review. Our interpretation of the literature suggests that AC (4 d, n=110) results in a shorter hospital stay than GA (9 d, n=116). Mean extent of resection was slightly less under awake conditions (41%, n=321) versus GA (44%, n=444), and postoperative deficits were less frequent under awake conditions (7%, n=411) versus GA (23%, n=520). Surgery time was slightly less in the AC group (165 min, n=324) versus GA (168 min, n=477). CONCLUSIONS:: Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Bispectral Index During Asleep-Awake Craniotomies.

  Valeria Conte, Camilla L'acqua, Stefano Rotelli, Nino Stocchetti
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  ABSTRACT: BACKGROUND:: Asleep-awake craniotomy presents challenges for the anesthetist who has to provide adequate sedation and analgesia but also requires an awake and cooperative patient for neurological testing. In this setting, we hypothesized that Bispectral Index (BIS) monitoring might be helpful in shortening the patient's awakening and in predicting recovery of consciousness in order to initiate reliable intraoperative brain mapping. METHODS:: An observational prospective study was performed on 27 consecutive asleep-awake craniotomies, in which BIS was monitored and BIS data collected offline. Nine critical intraoperative time points were defined and analyzed [preinduction, start of surgery, termination of hypnotic drug, eye opening, obeying simple commands, laryngeal mask airway (LMA) removal, initiation of brain mapping, initiation of closure, and end of surgery]. RESULTS:: A shorter time to LMA removal was associated with a higher BIS at the termination of the hypnotic drug (P=0.016, Mann-Whitney U test). From the initiation of surgery to the time of LMA removal, BIS was significantly lower than the preinduction values, whereas at the initiation of brain mapping, BIS returned to the preinduction values (Friedman test P<0.0001, Dunns multiple comparisons test). Compared with LMA removal, BIS values >85 predicted the initiation of brain mapping with a sensitivity of 44% (95% confidence interval, 25.5%-64.7%) and a specificity of 74% (95% confidence interval, 53.7%-89%). CONCLUSIONS:: During asleep-awake craniotomies, higher BIS values at the end of the asleep phase are associated with shorter time to LMA removal, suggesting that BIS monitoring may be beneficial in shortening recovery from anesthesia. During the awake phase, the return of BIS to the preinduction values appeared to indicate full recovery of consciousness, thereby allowing a reliable language testing.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: An Acute Neurological Syndrome With Cerebrovascular and Parkinsonian Clinical Features Associated With Perioperative SNRI Withdrawal.

  George W Williams, Samir J Gandhi, Alfonso Altamirano
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Report of 14th Annual ISNACC Conference at Varanasi, India.

  Gyaninder P Singh, Hemanshu Prabhakar
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Local Anesthetic Toxicity During Awake Craniotomy.

  Marco M Garavaglia, Gregory M T Hare, Michael D Cusimano
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Image-guided Intracranial Endosonography.

  Naureen Keric, Sven R Kantelhardt, Axel Neulen, Peter Dechent, Antonia Henning, Fritz C Vollmer, Ingmar Thiemann, Alf Giese
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  ABSTRACT: BACKGROUND:: Although the skull limits applicability of sonography, bedside intracranial endosonography might be an alternative to computed tomography scans to detect adverse events in sedated patients. However, the usefulness of intracranial endosonography for potential clinical application has not been evaluated. The present study was designed to investigate the suitability of an image-guided intracranial endosonography (IGIE) catheter for intracranial ultrasound imaging in an ex vivo phantom model and in a large animal model. MATERIALS AND METHODS:: IGIE was evaluated in a cranial phantom and a porcine intracranial hemorrhage (ICH) model. Two anesthetized animals underwent an initial magnetic resonance imaging (MRI) scan, followed by placement of an endosonography catheter in the frontal lobe. After anatomic imaging, an experimental ICH was placed in the contralateral hemisphere. B-scan imaging, duplex, Doppler sonography, and a second MRI were performed. A standard image-guiding device tracked the ultrasound catheter. RESULTS:: Endosonography provided high-definition imaging of intracranial structures. Image guidance allowed direction of the catheter to and intuitive identification of anatomic structures. Doppler imaging allowed analysis of blood flow in intracranial vessels. Ultrasound imaging was used to monitor evolution of ICH and the resulting brain edema in real time. Coregistration of ultrasound and MRI images acquired after ICH placement demonstrated the high accuracy of the spatial resolution of IGIE (largest mismatch <5 mm). CONCLUSIONS:: IGIE provides high-definition images of intracranial structures, Doppler analysis of blood flow, and real-time monitoring of intracranial structural lesions. We suggest that IGIE might prove a valuable tool for intracranial monitoring of sedated patients over extended time periods.
  Journal of neurosurgical anesthesiology 04/2013;
• Article: Unanticipated Blood Loss and Management of a Patient With Bombay Phenotype Coming for Bone Flap Replacement: A Lesson Learnt.

  Byrappa Vinay, Totappa S Devaragudi
  Journal of neurosurgical anesthesiology 04/2013;
• Article: An Alternative Position for the BIS-Vista Montage in Frontal Approach Neurosurgical Cases.

  Priscilla Nelson, Jonas A Nelson, Alexander J Chen, W Andrew Kofke
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  ABSTRACT: : Appropriate placement of the bispectral index (BIS)-vista montage for frontal approach neurosurgical procedures is a neuromonitoring challenge. The standard bifrontal application interferes with the operative field; yet to date, no other placements have demonstrated good agreement. The purpose of our study was to compare the standard BIS montage with an alternate BIS montage across the nasal dorsum for neuromonitoring. : The authors performed a prospective study, enrolling patients and performing neuromonitoring using both the standard and the alternative montage on each patient. Data from the 2 placements were compared and analyzed using a Bland-Altman analysis, a Scatter plot analysis, and a matched-pair analysis. : Overall, 2567 minutes of data from each montage was collected on 28 subjects. Comparing the overall difference in score, the alternate BIS montage score was, on average, 2.0 (6.2) greater than the standard BIS montage score (P<0.0001). The Bland-Altman analysis revealed a difference in score of -2.0 (95% confidence interval, -14.1, 10.1), with 108/2567 (4.2%) of the values lying outside of the limit of agreement. The scatter plot analysis overall produced a trend line with the equation y=0.94x+0.82, with an R coefficient of 0.82. : We determined that the nasal montage produces values that have slightly more variability compared with that ideally desired, but the variability is not clinically significant. In cases where the standard BIS-vista montage would interfere with the operative field, an alternative positioning of the BIS montage across the nasal bridge and under the eye can be used.
  Journal of neurosurgical anesthesiology 04/2013; 25(2):135-42.
• Article: Neuraxial Anesthesia in CADASIL Syndrome.

  James J Lamberg, Verghese T Cherian
  Journal of neurosurgical anesthesiology 04/2013; 25(2):216.
• Article: In reply.

  Rudrashish Haldar, Prakhar Gyanesh, Guruprasad Bettaswamy
  Journal of neurosurgical anesthesiology 04/2013; 25(2):207-8.
• Article: Hiccups in the Neuro ICU: A Problem of Respiratory Support.

  Vladimir V Merenkov, Alexey N Kovalev
  Journal of neurosurgical anesthesiology 04/2013; 25(2):209-10.
• Article: Revisiting Gastric Decompression Tube Insertion After Endonasal Neurosurgery: Blamed if You do, Blamed if You Do Not.

  Priscilla Nelson, Paul M Kempen, W Andrew Kofke
  Journal of neurosurgical anesthesiology 04/2013; 25(2):215.