scholarly journals Lidocaine versus magnesium sulfate infusion during isoflurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial

2021 ◽  
Keyword(s):  
Brain Tumor ◽  
Magnesium Sulfate ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Minimum Alveolar Concentration ◽  
Tumor Resection ◽  
Loading Dose ◽  
Depth Of Anesthesia ◽  
Lidocaine Group ◽  
Significant Difference

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.

scholarly journals Intelligence Deficits in Chinese Patients with Brain Tumor: The Impact of Tumor Resection

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Chao Shen ◽  
Rong Xie ◽  
Xiaoyun Cao ◽  
Weimin Bao ◽  
Bojie Yang ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pituitary Adenoma ◽  
Tumor Resection ◽  
Chinese Patients ◽  
Adult Intelligence Scale ◽  
Wechsler Adult Intelligence Scale ◽  
Significant Difference ◽  
And Performance ◽  
The Right ◽  
The Impact

Background. Intelligence is much important for brain tumor patients after their operation, while the reports about surgical related intelligence deficits are not frequent. It is not only theoretically important but also meaningful for clinical practice.Methods. Wechsler Adult Intelligence Scale was employed to evaluate the intelligence of 103 patients with intracranial tumor and to compare the intelligence quotient (IQ), verbal IQ (VIQ), and performance IQ (PIQ) between the intracerebral and extracerebral subgroups.Results. Although preoperative intelligence deficits appeared in all subgroups, IQ, VIQ, and PIQ were not found to have any significant difference between the intracerebral and extracerebral subgroups, but with VIQ lower than PIQ in all the subgroups. An immediate postoperative follow-up demonstrated a decline of IQ and PIQ in the extracerebral subgroup, but an improvement of VIQ in the right intracerebral subgroup. Pituitary adenoma resection exerted no effect on intelligence. In addition, age, years of education, and tumor size were found to play important roles.Conclusions. Brain tumors will impair IQ, VIQ, and PIQ. The extracerebral tumor resection can deteriorate IQ and PIQ. However, right intracerebral tumor resection is beneficial to VIQ, and transsphenoidal pituitary adenoma resection performs no effect on intelligence.

scholarly journals Impact of Anticipated Awake Surgery on Psychooncological Distress in Brain Tumor Patients

2022 ◽  
Vol 11 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Oliver Radtke ◽  
Daniel Hänggi ◽  
Michael Sabel ◽  
Marion Rapp
Keyword(s):  
Brain Tumor ◽  
Significant Influence ◽  
Tumor Resection ◽  
Statistical Analyses ◽  
Distress Thermometer ◽  
Awake Surgery ◽  
Anxiety And Depression ◽  
Cerebral Lesions ◽  
Tumor Patients ◽  
Significant Difference

BackgroundBrain tumor patients present high rates of distress, anxiety, and depression, in particular perioperatively. For resection of eloquent located cerebral lesions, awake surgery is the gold standard surgical method for the preservation of speech and motor function, which might be accompanied by increased psychological distress. The aim of the present study was to analyze if patients who are undergoing awake craniotomy suffer from increased prevalence or higher scores in distress, anxiety, or depression.MethodsPatients, who were electively admitted for brain tumor surgery at our neurooncological department, were perioperatively screened regarding distress, anxiety, and quality of life using three established self-assessment instruments (Hospital Anxiety and Depression Scale, distress thermometer, and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30-BN20). Screening results were correlated regarding operation technique (awake vs. general anesthesia). Retrospective statistical analyses for nominal variables were conducted using chi-square test. Metric variables were analyzed using the Kruskal–Wallis test, the Mann–Whitney U-test, and independent-samples t-tests.ResultsData from 54 patients (26 male and 28 female) aged 29 to 82 years were available for statistical analyses. A total of 37 patients received primary resection and 17 recurrent tumor resection. Awake surgery was performed in 35 patients. There was no significant difference in awake versus non-awake surgery patients regarding prevalence (of distress (p = 0.465), anxiety (p = 0.223), or depression (p = 0.882). Furthermore, awake surgery had no significant influence on distress thermometer score (p = 0.668), anxiety score (p = 0.682), or depression score (p = 0.630) as well as future uncertainty (p = 0.436) or global health status (p = 0.943). Additionally, analyses revealed that primary or recurrent surgery also did not have any significant influence on the prevalence or scoring of the evaluated items.ConclusionAnalyses of our cohort’s data suggest that planned awake surgery might not have a negative impact on patients concerning the prevalence and severity of manifestation of distress, anxiety, or depression in psychooncological screening. Patients undergoing recurrent surgery tend to demonstrate increased distress, although results were not significant.

Epidural Lidocaine Decreases Sevoflurane Requirement for Adequate Depth of Anesthesia as Measured by the Bispectral Index ®  Monitor

2001 ◽  
Vol 94 (5) ◽  
pp. 799-803 ◽  
Author(s):  
Peter S. Hodgson ◽  
Spencer S. Liu
Keyword(s):  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Bispectral Index ◽  
Depth Of Anesthesia ◽  
Intravenous Lidocaine ◽  
Lidocaine Group ◽  
Plasma Lidocaine ◽  
Intravenous Saline ◽  
End Tidal ◽  
To Receive

Background Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC). The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index (BIS). Methods After premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl, 30 patients aged 20-65 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus dose; 25 microg x kg(-1) x min(-1)). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients received 4 mg/kg thiopental and 1 mg/kg rocuronium for tracheal intubation. After 10 min of a predetermined end-tidal sevoflurane concentration, BIS was measured. The ED50 of sevoflurane for each group was determined by up-down methodology based on BIS less than 50 (MAC(BIS50)). Plasma lidocaine concentrations were measured. Results The MAC(BIS50) of sevoflurane (0.59% end tidal) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (0.92%) or with intravenous lidocaine (1%; P < 0.0001). Plasma lidocaine concentrations in the intravenous lidocaine group (1.9 microg/ml) were similar to those in the epidural lidocaine group (2.0 microg/ml). Conclusions Epidural anesthesia reduced by 34% the sevoflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocaine absorbtion, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

scholarly journals The Influence of Household Income on Survival following Posterior Fossa Tumor Resection at a Large Academic Medical Center

2020 ◽  
Author(s):  
Rachel Blue ◽  
Donald K. Detchou ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Michael Spadola ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Brain Tumor ◽  
Posterior Fossa ◽  
Household Income ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Academic Medical ◽  
Significant Difference

Abstract Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population. Design This is a retrospective regression analysis. Setting The study conducted at a single, multihospital, urban academic medical center. Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis. Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables. Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed. Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.

scholarly journals Effect of Bispectral Index-Guided Total Intravenous Anesthesia on Post-Anesthetic Recovery Outcomes in High-Risk Children: A Prospective, Randomized, Controlled Trial

2021 ◽  
Author(s):  
Guoliang Liu ◽  
Lijing Li ◽  
Xuemei Zhang ◽  
Xiaoxue Wang ◽  
Lei Hua ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Bispectral Index ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Depth Of Anesthesia ◽  
Intravenous Anesthesia ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Significant Difference ◽  
Group B

Abstract BACKGROUND TIVA is widely used in children, but few studies have attempted to evaluation of the effect of BIS-guided propofol infusion than that on conventional methods on recovery outcomes in children with higher risk factors.OBJECTIVETo evaluate the effect of bispectral index (BIS) guidance during total intravenous anesthesia on post-anesthetic recovery outcomes in children at higher risk during anesthesia. DESIGNA prospective, randomized, controlled trial. SETTING University medical centre.PATIENTSThis study enrolled 472 children (aged 1-14 years) who met the higher-risk scoring criteria and were scheduled for surgery under total intravenous anesthesia. INTERVENTIONThe children were randomly assigned to the BIS group (group B) and standard clinical practice group (group S). The BIS values in group B were maintained at 45–60. The anesthesiologist controlled the depth of anesthesia in group S according to the variation in the clinical signs of the children. MAIN OUTCOME MEASURESBIS values, heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation at each time points, as well as the time between drug withdrawal to extubation, duration of stay in the post-anesthesia care unit (PACU), the total amount of propofol used, and postoperative adverse reactions were recorded. RESULTSThere was no significant difference in time from stopping propofol infusion to extubation and duration of PACU between the groups . There was no significant difference in BIS values between the groups at T2, T3, and T8. BIS values at T1, T4, T5, T6, and T7 in group B were lower than those in group S. There was no statistically significant difference in the HR between the groups. MAP in group B was lower than in group S at T5, T6, T7, and T8. The total amount of propofol administered in group B was higher than in group S. CONCLUSIONThe use of BIS-guided total intravenous anesthesia in higher-risk children can maintain the proper depth of anesthesia but does not prolong the time of extubation and the duration of stay in the PACU.TRIAL REGISTRATION Chictr.org.cn identifier: 24/11/2017 , ChiCTR-IOR-17013530

scholarly journals MET-08 Air in cistern or ventricle after brain metastasis surgery is a predictor of early postoperative intracranial recurrence

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii19-ii19
Author(s):  
Yusuke Ikeuchi ◽  
Masamitsu Nishihara ◽  
Noriaki Ashida ◽  
Takashi Sasayama ◽  
Kohkichi Hosoda
Keyword(s):  
Brain Tumor ◽  
Local Recurrence ◽  
Brain Metastasis ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
En Bloc Resection ◽  
Postoperative Recurrence ◽  
Competing Risk ◽  
En Bloc ◽  
Significant Difference

Abstract INTRODUCTION: The operations of brain metastasis are on the increase as a result of more routine diagnostic imaging and improved extracranial systemic treatment strategies. Opening of the cistern or ventricle during tumor resection may promote local recurrence and cerebrospinal fluid dissemination. We investigated whether the air found in the cistern/ventricle on postoperative Computed tomography (CT) was a predictor of postoperative recurrence. METHODS: Between 2012 and 2019, 27 patients with single brain metastasis were treated with gross total resection at our hospital. The patients in which air was found in the cistern or ventricle of the head CT on the day after surgery was designated as air(+) group, and the patients without air was designated as air(-) group. The primary outcome was the local recurrence, as diagnosed with neuroimaging. The death due to other than brain metastasis was defined as competing risk. RESULTS: CT air(+) group was 17 patients, whereas CT air(-) group was 10 patients. There was no significant difference between the two groups, such as age and sex. Estimated 1-year brain tumor recurrence rate was 70% in the air(+) group and 5.9% in the air(-) group. (p = 0.004). On the other hand, no significant difference was observed in estimated 1-year competing risk between in the air(+) group (10%) and in the air(-) group (2.4%). CONCLUSION: En bloc resection of brain metastasis is effective, but there was no report on the risk of opening the cistern or ventricle. Our results indicate that postoperative air presence in the cistern or ventricle could be a predictor of early postoperative recurrence. In metastatic brain tumor removal, the cistern and ventricle should not be opened, and close follow-up should be done if air in the cistern or ventricle is detected on postoperative CT.

Effect of Low-dose Lidocaine on Motor Evoked Potentials in Patients Undergoing Intracranial Tumor Resection With Propofol Anesthesia

2021 ◽  
Author(s):  
Meijuan Liu ◽  
Ning Wang ◽  
Dong Wang ◽  
Juan Liu ◽  
Wenjie Jin
Keyword(s):  
Adverse Events ◽  
Evoked Potentials ◽  
Low Dose ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Intracranial Tumor ◽  
Anesthesia Induction ◽  
Total Dosage ◽  
Lidocaine Group ◽  
Significant Difference

Abstract ObjectTo investigate the effect of low-dose lidocaine on motor evoked potentials (MEP) in patients undergoing intracranial tumor resection with propofol anesthesia.MethodsForty patients undergoing intracranial tumor resection and required MEP monitoring were selected.They were randomly divided into the lidocaine group (Group L, n=20) and control group (Group C, n=20) by computer generated randomization. All patients were given propofol anesthesia under the guidance of bispectral index (BIS).In Group L, lidocaine 1 mg/kg was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at the speed of 1 mg/kg·h until the operation start. Group C was given the equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and BIS were recorded before anesthesia induction (T0), 2 min after tracheal intubation (T1), 35 min (T2) and 50 min (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol, and adverse events before T3 were recorded.ResultsCompared with Group C, HR and MAP were significantly decreased at T1 in Group L. No significant difference was observed in HR and MAP at T0, T2 and T3 between Group L and Group C. The total dosage of propofol and the incidence of adverse events were significantly lower in Group L than in Group C before T3. There was no significant difference in the amplitude and latency of MEP between the two groups at each time point.ConclusionLow-dose lidocaine has no effect on MEP in patients undergoing intracranial tumor resection. In addition, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.

scholarly journals Postoperative Admission of Adult Craniotomy Patients to Neuroscience Floor Unit Reduces Cost and Length of Stay

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Matthew Z Sun ◽  
Diana Babayan ◽  
Jia-Shu Chen ◽  
Maxwell Wang ◽  
Priyanka Naik ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Length Of Stay ◽  
Hospital Cost ◽  
Tumor Resection ◽  
Adult Brain ◽  
University Hospital ◽  
Actual Length ◽  
Discharge Disposition ◽  
Significant Difference ◽  
The Cost

Abstract INTRODUCTION The neurointensive care unit (NICU) is costly but has traditionally been the default recovery unit after adult elective craniotomies for brain tumor resection. Given the rising healthcare costs and associated change in practice patterns, we assessed whether admitting these patients to a neuroscience floor unit instead of NICU for recovery resulted in an equivalent outcome while reducing the cost and length of stay. METHODS We retrospectively analyzed the clinical and cost data of all adult brain tumor elective supratentorial craniotomy patients at a university hospital within the last 5 yr who had a length of stay of less than 7 d. We compared those who stayed in the ICU for 1 d during admission versus those who did not stay in the ICU. Patients undergoing shunts, endoscopic, burr hole craniotomies, posterior fossa craniotomies, and vascular procedures were excluded. RESULTS A total of 688 patients were included, with 428 patients staying in the NICU for 1 d (NICU1) and 259 not staying in the NICU (NICU0). There was no difference in University Hospital Consortium (UHC) expected length of stay (P = .338). However, the actual length of stay for the NICU1 group was 12 h longer than the NICU0 group (3.6 vs 3.1 d) (P < .0001), and the difference was still significant in multivariate analysis controlling for age, MS DRG, OR hours, insurance type, discharge disposition, and admit day. While the NICU1 group had longer surgeries (mean OR hours charged 6.8 vs 6.5 h), there was no statistically significant difference in the cost of surgery. The NICU0 group reduced the direct hospital cost by $3070 per admission on average (P < .001). Clinically, there were no statistically significant differences in the rate of return to OR, ED readmission, or hospital readmission within 30 d. CONCLUSION Admitting to a neuroscience floor unit reduced the length of stay and direct hospital cost associated with admission, without significant differences in clinical outcome.

scholarly journals Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Huan Wee Chan ◽  
Christopher Uff ◽  
Aabir Chakraborty ◽  
Neil Dorward ◽  
Jeffrey Colin Bamber
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Shear Wave Elastography ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Normal Brain ◽  
Mri Scan ◽  
Significant Difference ◽  
Brain Tumor Resection

BackgroundThe clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported.AimsTo determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”.MethodsThirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan.ResultsThe YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p &lt; 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p &lt; 0.001, respectively).ConclusionsSWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.

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