Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (P<0.05). Amsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

It may be feasible to perform awake craniotomies for removal of intracranial tumor as an ambulatory procedure; however, caution is advised. Patient selection must be stringent with respect to the patient's preoperative functional status, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.

In this study we compared the effectiveness of the use of remifentanil to fentanyl in conjunction with propofol in providing conscious sedation for awake craniotomy for tumor surgery and to assess patient satisfaction with both techniques. The ability to maintain appropriate levels of sedation, adequate analgesia, and hemodynamic stability was assessed in 50 patients randomized to receive either fentanyl or remifentanil. All complications were documented. Patients were interviewed at 1 h, 4 h, and 24 h after surgery to note their recall of procedure and pain and their overall satisfaction. There were no differences in sedation and pain scores or in hemodynamic and respiratory variables between the two groups. The incidence of intraoperative complications was not different (fentanyl, 14; remifentanil, 16). Respiratory complications occurred in 9 (18%) patients (fentanyl 6, remifentanil 3). The recall and satisfaction scores were not different; 93% of all patients were completely satisfied at all interview times. The use of remifentanil infusion in conjunction with propofol is a good alternative to fentanyl and propofol for conscious sedation for the awake craniotomy and these techniques are both well accepted by the patient.

No abstract

Deep brain stimulation is used for the treatment of patients with neurologic disorders who have an alteration of function, such as movement disorders and other chronic illnesses. The insertion of the deep brain stimulator (DBS) is a minimally invasive procedure that includes the placement of electrodes into deep brain structures for microelectrode recordings and intraoperative clinical testing and connection of the DBS to an implanted pacemaker. The anesthetic technique varies depending on the traditions and requirements of each institution performing these procedures and has included monitored anesthesia with local anesthesia, conscious sedation, and general anesthesia. The challenges and demands for the anesthesiologist in the care of these patients relate to the specific concerns of the patients with functional neurologic disorders, the effects of anesthetic drugs on microelectrode recordings, and the requirements of the surgical procedure, which often include an awake and cooperative patient. The purpose of this review is to familiarize anesthesiologists with deep brain stimulation by discussing the mechanism, the effects of anesthetic drugs, and the surgical procedure of DBS insertion, and the perioperative assessment, preparation, intraoperative anesthetic management, and complications in patients with functional neurologic disorders.

Electrocardiographic (ECG) changes are reported frequently after subarachnoid haemorrhage (SAH). The aim of this study was to investigate the functional significance of ECG changes by echocardiographic assessment of cardiac function. Forty-five patients with intracranial aneurysms were studied. All patients had a 12-lead ECG and a two-dimensional echocardiogram. After patients with an history of chronic cardiac disease (n = 4) were excluded, only four patients were found to have wall motion abnormalities. These patients had only minor ECG abnormalities, but severe neurological dysfunction. Conversely, patients with other ECG abnormalities including the deep inverted T waves associated usually with SAH, had normal echocardiograms. We conclude that the ECG is not an accurate predictor of myocardial function after SAH and that myocardial dysfunction is related more closely to severity of neurological condition.

Hyperglycemia should be avoided during neurosurgery in order to decrease the risk of neurological injury. Dexamethasone has been associated with increased blood glucose during surgery. In this prospective, nonrandomized study, we documented the blood glucose concentration changes for 12 h in 34 nondiabetic patients undergoing craniotomy and compared patients who received intraoperative dexamethasone (10 mg IV on induction and 4 mg IV 6 h later), with or without preoperative dexamethasone, with patients who did not receive dexamethasone. Blood glucose concentrations increased from the preinduction value in all groups. Patients not taking dexamethasone before surgery, but who were given it intra- and postoperatively, had the largest peak blood glucose concentrations (11.0 +/- 2.0 mmol/L, mean +/- sd; P< 0.01) compared with patients who received no dexamethasone (7.8 +/- 2.1 mmol/L) or those who had been taking dexamethasone before surgery and continued it during surgery (8.5 +/- 1.2 mmol/L). The peak blood glucose concentrations in this group occurred 9 +/- 2 h after the induction of anesthesia. We recommend that the blood glucose concentration be monitored for at least 12 h in nondiabetic patients having neurosurgery who are newly administered dexamethasone.

NCT01545297.