Superficial temporal artery–middle cerebral artery bypass using local anesthesia and a sedative without endotracheal general anesthesia

Kaku, Yasuhiko; Yamashita, Kentaro; Kokuzawa, Jouji; Kanou, Kiyomitsu; Tsujimoto, Masanori

doi:10.3171/2012.4.jns111958

Cited by 12 publications

(4 citation statements)

References 21 publications

(19 reference statements)

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“…Studies have shown that several types of adverse events can disturb cerebral oxygen delivery under general anesthesia, but no changes are observed with routine intraoperative monitoring methods (Kaku, Yamashita, Kokuzawa, Kanou, & Tsujimoto, ). Hence, general anesthesia is considered the first choice for EITs by most experts (Hoshino et al, ).…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Справедливости ради следует заметить, что это не первое такое клиническое наблюдение. Первенство здесь принадлежит японским авторам [72], но кто бы ни был первым, очевидно, что это еще одно поле деятельности для нейрохирургии в сознании.…”

Section: создание экстра-интракраниального микрососудистого анастомозunclassified

Neurosurgery in conscious patients: forward to the past

Lubnin

2018

Vopr. neirokhir.

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We present an analytical review of various neurosurgical interventions in conscious patients. An analysis of the literature indicates growing interest in this problem. Craniotomy in conscious patients has been extensively used in resection of space-occupying cerebral lesions in the eloquent hemispheric areas and in epilepsy surgery. In recent years, there have been a number of reports on interventions in conscious patients with other neurosurgical pathologies, which may be regarded as a new emerging tendency in neurosurgery and neuroanesthesiology. Neurosurgery in conscious patients provides a special advantage because it enables highly functional neuromonitoring without use of complex devices.

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“…48 The second question aims to identify subgroups of patients that would benefit from bypass. 37 There are distinct subgroups of patients, for whom COSS was not specifically designed: patients with chronic retinal ischemia resulting in progressive visual loss and patients presenting with ongoing hemodynamic symptoms despite optimal medical therapy.…”

Section: Considerations In Patients With Atherosclerotic Steno-occlusmentioning

confidence: 99%

“…И, наконец, технические инновации, такие как система-тизированное применение миникраниотомии (2-2,5 см), могут представлять собой возможность снижения часто-ты развития послеоперационных осложнений [48].…”

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Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?

Esposito

Amin‐Hanjani

Regli

2016

Stroke

103

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Superficial temporal artery–middle cerebral artery bypass using local anesthesia and a sedative without endotracheal general anesthesia

Abstract: This initial experience confirms the feasibility of performing STA-MCA bypass without endotracheal general anesthesia. This novel technique produced a high degree of patient satisfaction.

Cited by 12 publications

References 21 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

Neurosurgery in conscious patients: forward to the past

Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?

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