scholarly journals Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs anesthesia induction in neurosurgical patients

Medicine ◽  
2019 ◽  
Vol 98 (3) ◽  
pp. e14144 ◽  
Author(s):  
Jin Hee Ahn ◽  
Doyeon Kim ◽  
Ik Soo Chung ◽  
Jeong Jin Lee ◽  
Eun Kyung Lee ◽  
...  
Keyword(s):  
Anesthesia Induction ◽  
Neurosurgical Patients

scholarly journals Left Frontal Lobe Tumor-Induced Intraoperative Premature Ventricular Beats

2021 ◽  
Author(s):  
Parmod K. Bithal ◽  
Ravees Jan ◽  
Bharani Kumar ◽  
Insha ur Rahman
Keyword(s):  
Blood Gases ◽  
Postoperative Recovery ◽  
Anesthesia Induction ◽  
Raised Intracranial Pressure ◽  
Normal Blood Pressure ◽  
Left Frontal Lobe ◽  
Premature Ventricular Contractions ◽  
Cardiac Pathology ◽  
Neurosurgical Patients ◽  
Cardiac Evaluation

AbstractIn the absence of cardiac pathology, premature ventricular contractions (PVCs) in neurosurgical patients frequently accompany subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, or raised intracranial pressure. PVCs detected during preanesthesia assessment prompts detailed cardiac evaluation. Our 57-year-old patient, a case of left frontal meningioma, with controlled hypertension, diabetes and hypothyroidism, had normal preoperative ECG and potassium. However, immediately on anesthesia induction, she developed multiple refractory to treatment PVCs but with normal blood pressure. Anesthesia, which was maintained with sevoflurane and fentanyl, was deepened to exclude light anesthesia as the cause, without useful outcome. Two lignocaine boluses (100 mg each), followed by its infusion, also proved ineffective. Her blood gases and potassium, checked twice, were normal. Throughout, her hemodynamics remained stable. As soon as tumor was removed, the PVCs disappeared not to return. Her postoperative recovery was uneventful with normal ECG.

TRACHEOSTOMY IN CRITICALLY ILL NEUROSURGICAL PATIENTS

2001 ◽  
Vol 5 (1) ◽  
pp. A5-A5
Author(s):  
Keith Y.C. Goh ◽  
Wendy Teoh ◽  
Chumpon Chan
Keyword(s):  
Critically Ill ◽  
Neurosurgical Patients

Effects of Intermittent Pneumatic Calf Compression On Postoperative Thrombin and Plasmin Activity

1986 ◽  
Vol 56 (02) ◽  
pp. 198-201 ◽  
Author(s):  
Jeffrey Weitz ◽  
Jost Michelsen ◽  
Kenneth Gold ◽  
John Owen ◽  
Duncan Carpenter
Keyword(s):  
Enzyme Activity ◽  
Fibrinopeptide A ◽  
Plasmin Activity ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Calf Compression

SummaryA previous study of neurosurgical patients demonstrated an imbalance between thrombin and plasmin action following surgery. The present study was designed to determine the effect of intermittent pneumatic calf compression on postoperative enzyme activity. Fibrinopeptide A (FPA) and Bβ 1-42 levels, reflecting thrombin and plasmin action respectively, were measured daily in patients undergoing elective craniotomy. Two of 9 patients not receiving calf compression developed positive fibrinogen leg scans, while none of 5 patients receiving prophylaxis had positive scans. Calf compression was associated with a markedly altered pattern of changes in the fibrinopeptide values following surgery. Without compression, there was perturbation of the balance between thrombin and plasmin action on the day after surgery as reflected by an increase in the FPA/Bβ 1-42 ratio. In contrast, in those receiving prophylaxis there was no change in this ratio on the first postoperative day. Calf compression both blunted the mean postoperative increase in the FPA level (1.8 nM vs 4.7 nM; p <.05) and augmented the mean Bβ 1-42 value (3.0 nM vs 0.2 nM; p <.05) so that the mean increase in the FPA/ Bβ 1-42 ratio was only 0.1 with calf compression as compared to 2.2 without it (p <.05). Systemic modulation of both the coagulation and fibrinolytic pathways thus occurred in association with calf compression.

Correlation of perioperative risk scores with hospital costs in neurosurgical patients

2020 ◽  
Vol 132 (3) ◽  
pp. 818-824
Author(s):  
Sasha Vaziri ◽  
Joseph M. Abbatematteo ◽  
Max S. Fleisher ◽  
Alexander B. Dru ◽  
Dennis T. Lockney ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Risk Scores ◽  
Site Infection ◽  
Risk Calculator ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Neurosurgical Patients ◽  
Predicted Risk

OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs.METHODSA single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs.RESULTSThe Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005).CONCLUSIONSPrevious work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.

Context-dependent relationship in high-resolution micro-ECoG studies during finger movements

2020 ◽  
Vol 132 (5) ◽  
pp. 1358-1366
Author(s):  
Chao-Hung Kuo ◽  
Timothy M. Blakely ◽  
Jeremiah D. Wander ◽  
Devapratim Sarma ◽  
Jing Wu ◽  
...  
Keyword(s):  
High Resolution ◽  
Sensorimotor Cortex ◽  
Index Finger ◽  
Hand Movement ◽  
Cortical Activation ◽  
Hand Movements ◽  
Finger Movements ◽  
Thumb Movement ◽  
Neurosurgical Patients ◽  
The Relationship

OBJECTIVEThe activation of the sensorimotor cortex as measured by electrocorticographic (ECoG) signals has been correlated with contralateral hand movements in humans, as precisely as the level of individual digits. However, the relationship between individual and multiple synergistic finger movements and the neural signal as detected by ECoG has not been fully explored. The authors used intraoperative high-resolution micro-ECoG (µECoG) on the sensorimotor cortex to link neural signals to finger movements across several context-specific motor tasks.METHODSThree neurosurgical patients with cortical lesions over eloquent regions participated. During awake craniotomy, a sensorimotor cortex area of hand movement was localized by high-frequency responses measured by an 8 × 8 µECoG grid of 3-mm interelectrode spacing. Patients performed a flexion movement of the thumb or index finger, or a pinch movement of both, based on a visual cue. High-gamma (HG; 70–230 Hz) filtered µECoG was used to identify dominant electrodes associated with thumb and index movement. Hand movements were recorded by a dataglove simultaneously with µECoG recording.RESULTSIn all 3 patients, the electrodes controlling thumb and index finger movements were identifiable approximately 3–6-mm apart by the HG-filtered µECoG signal. For HG power of cortical activation measured with µECoG, the thumb and index signals in the pinch movement were similar to those observed during thumb-only and index-only movement, respectively (all p > 0.05). Index finger movements, measured by the dataglove joint angles, were similar in both the index-only and pinch movements (p > 0.05). However, despite similar activation across the conditions, markedly decreased thumb movement was observed in pinch relative to independent thumb-only movement (all p < 0.05).CONCLUSIONSHG-filtered µECoG signals effectively identify dominant regions associated with thumb and index finger movement. For pinch, the µECoG signal comprises a combination of the signals from individual thumb and index movements. However, while the relationship between the index finger joint angle and HG-filtered signal remains consistent between conditions, there is not a fixed relationship for thumb movement. Although the HG-filtered µECoG signal is similar in both thumb-only and pinch conditions, the actual thumb movement is markedly smaller in the pinch condition than in the thumb-only condition. This implies a nonlinear relationship between the cortical signal and the motor output for some, but importantly not all, movement types. This analysis provides insight into the tuning of the motor cortex toward specific types of motor behaviors.

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