Outcomes in neuroanesthesia: What matters most?

Flexman, Alana M.; Meng, Lingzhong; Gelb, Adrian W.

doi:10.1007/s12630-015-0522-9

Cited by 24 publications

(12 citation statements)

References 52 publications

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“…Rapid recovery from neuroanesthesia and early neurologic examination are also important. Hemodynamic stability, especially with regard to arterial pressure to aid adequate cerebral perfusion, is a cornerstone of neuroanesthesia management (Flexman, Meng, & Gelb, ; Kundra, Mahendru, & Gupta, ). Studies have reported that 40%–80% of neurosurgical patients experience moderate‐to‐severe postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Ren

et al. 2019

Brain and Behavior

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Background Rapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs. Methods Eighty‐six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg−1 hr−1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg−1 hr−1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery. Results Dexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days. Conclusions Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.

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Section: Introductionmentioning

confidence: 99%

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Ren

et al. 2019

Brain and Behavior

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“…Awake craniotomy is the preferred technique to facilitate clinical monitoring during the surgical management of tumors in the eloquent brain. 9,43 If general anesthesia is required, it must be provided with agents that facilitate rapid intraoperative awakening to assure high-quality functional testing. Xenon has a theoretical advantage of combining both safe ventilation and rapid awakening.…”

Section: Prevention and Early Detection Of Intraoperative/postoperatimentioning

confidence: 99%

Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures

Rylova

Maze

2019

Journal of Neurosurgical Anesthesiology

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Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients.

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“…Inhalational anesthesia and intravenous anesthesia are widely used in current neurosurgical anesthesiology [2], and sevoflurane combined with remifentanil or propofol combined with remifentanil are both accepted as general anesthesia strategies. Comparative studies have been done to investigate the effects of different anesthetics on craniotomies [3], both primary and secondary outcomes focused on the changes in intraoperative physiological parameters [3,4], laboratory results [3], and anesthesia recovery indices during emergence [5,6]; however, neuronal disease-specific study is lacking, and there is no evidence related to how postoperative neurological function and neurocognitive outcomes are affected by different general anesthesia strategies [7].…”

Section: Subject Areasmentioning

confidence: 99%

Sevoflurane versus PRopofol Combined with Remifentanil Anesthesia Impact on Postoperative Neurologic Function in Supratentorial Gliomas (SPRING): Protocol for a Randomized Controlled Trial

Xing

LIN

Han

et al. 2019

Preprint

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Background Patients with intracranial tumors are more sensitive to sedatives and general anesthetics than the general population and are therefore more susceptible to postoperative neurologic and neurocognitive dysfunction. Sevoflurane or propofol combined with remifentanil are widely used general anesthetic regimens for craniotomy, with neither regimen shown to be superior to the other in terms of neuroprotective efficacy and anesthesia quality. There is no evidence regarding the variable effects on postoperative neurologic and neurocognitive functional outcome under these two general anesthetic regimens. This trial will compare inhalational sevoflurane or intravenous propofol combined with remifentanil anesthesia in patients with supratentorial gliomas and test the hypothesis that postoperative neurologic function is equally affected between the two, as well as evaluate postoperative neurocognitive function, hemodynamics, and anesthesia quality among them. Methods This is a prospective, single-center, randomized parallel arm equivalent clinical trial, which is approved by China Ethics Committee of Registering Clinical Trials (ChiECRCT-20160051). Patients with supratentorial gliomas diagnosed by magnetic resonance imaging will be eligible for the trial. Written informed consent will be obtained before randomly assigning each subject to either the sevoflurane-remifentanil or propofol-remifentanil group for anesthesia maintenance to achieve an equal-desired depth of anesthesia. Intraoperative intervention and monitoring will follow a standard anesthetic management protocol. All of the physiological parameters and other medications administered during the intervention will be recorded. The primary outcome will be neurologic function assessed by National Institute of Health Stroke Scale (NIHSS) and modified NIHSS within two days after general anesthesia. Secondary outcomes will include hemodynamic stability, intraoperative brain relaxation, quality of anesthesia emergence, quality of anesthesia recovery, postoperative cognitive function, postoperative pain, postoperative neurologic complications, perioperative medical expense, as well as blood and urine stress response biomarkers. Discussion This randomized equivalency trial will primarily compare the impacts of sevoflurane-remifentanil and propofol-remifentanil anesthesia on short-term postoperative neurologic function in patients with supratentorial gliomas undergoing craniotomy. The exclusion criteria are strict to ensure that the groups are comparable in all aspects. Repeated and routine neurologic evaluations after operation are always important to evaluate neurosurgical patients’ recovery and any newly presenting complications. The results of this trial would help specifically to interpret anesthetic residual effects on postoperative outcomes, and perhaps would help the anesthesiologist to select the optimal anesthetic regimen to minimize its impact on neurologic function in this specific patient population.

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Outcomes in neuroanesthesia: What matters most?

Cited by 24 publications

References 52 publications

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures

Sevoflurane versus PRopofol Combined with Remifentanil Anesthesia Impact on Postoperative Neurologic Function in Supratentorial Gliomas (SPRING): Protocol for a Randomized Controlled Trial

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