scholarly journals COVID-19: changing patterns among neurosurgical patients from North India, efficacy of repeat testing, and inpatient prevalence

2020 ◽  
Vol 49 (6) ◽  
pp. E7 ◽  
Author(s):  
Sushanta K. Sahoo ◽  
Sivashanmugam Dhandapani ◽  
Apinderpreet Singh ◽  
Chandrashekhar Gendle ◽  
Madhivanan Karthigeyan ◽  
...  
Keyword(s):  
Local Community ◽  
North India ◽  
Polymerase Chain Reaction Test ◽  
Neurosurgical Procedures ◽  
Repeated Testing ◽  
Probable Number ◽  
Period Prevalence ◽  
Number Of Patients ◽  
Neurosurgical Patients ◽  
Changing Patterns

OBJECTIVECOVID-19 has affected surgical practice globally. Treating neurosurgical patients with the restrictions imposed by the pandemic is challenging in institutions with shared patient areas. The present study was performed to assess the changing patterns of neurosurgical cases, the efficacy of repeated testing before surgery, and the prevalence of COVID-19 in asymptomatic neurosurgical inpatients.METHODSCases of non–trauma-related neurosurgical patients treated at the Postgraduate Institute of Medical Education and Research (PGIMER) before and during the COVID-19 pandemic were reviewed. During the pandemic, all patients underwent a nasopharyngeal swab reverse transcription–polymerase chain reaction test to detect COVID-19 at admission. Patients who needed immediate intervention were surgically treated following a single COVID-19 test, while stable patients who initially tested negative for COVID-19 were subjected to repeated testing at least 5 days after the first test and within 48 hours prior to the planned surgery. The COVID-19 positivity rate was compared with the local period prevalence. The number of patients who tested positive at the second test, following a negative first test, was used to determine the probable number of people who could have become infected during the surgical procedure without second testing.RESULTSOf the total 1769 non–trauma-related neurosurgical patients included in this study, a mean of 337.2 patients underwent surgery per month before COVID-19, while a mean of 184.2 patients (54.6% of pre–COVID-19 capacity) underwent surgery per month during the pandemic period, when COVID-19 cases were on the rise in India. There was a significant increase in the proportion of patients undergoing surgery for a ruptured aneurysm, stroke, hydrocephalus, and cerebellar tumors, while the number of patients seeking surgery for chronic benign diseases declined. At the first COVID-19 test, 4 patients (0.48%) tested were found to have the disease, a proportion 3.7 times greater than that found in the local community. An additional 5 patients tested positive at the time of the second COVID-19 test, resulting in an overall inpatient period prevalence of 1%, in contrast to a 0.2% national cumulative caseload. It is possible that COVID-19 was prevented in approximately 67.4 people every month by using double testing.CONCLUSIONSCOVID-19 has changed the pattern of neurosurgical procedures, with acute cases dominating the practice. Despite the fact that the pandemic has not yet reached its peak in India, COVID-19 has been detected 3.7 times more often in asymptomatic neurosurgical inpatients than in the local community, even with single testing. Double testing displays an incremental value by disclosing COVID-19 overall in 1 in 100 inpatients and thus averting its spread through neurosurgical services.

scholarly journals Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Medicina ◽  
2018 ◽  
Vol 54 (2) ◽  
pp. 22 ◽  
Author(s):  
Jomantė Mačiukaitienė ◽  
Diana Bilskienė ◽  
Arimantas Tamašauskas ◽  
Adomas Bunevičius
Keyword(s):  
Prothrombin Complex Concentrate ◽  
International Normalized Ratio ◽  
Intracranial Bleeding ◽  
Neurosurgical Procedures ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Neurosurgical Patients ◽  
Gcs Score ◽  
Emergent Surgery ◽  
Neurosurgical Intervention

Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p < 0.01), PT (p < 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were ≤3.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention.

scholarly journals Intraoperative protective ventilation in patients undergoing major neurosurgical interventions: a randomized clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Federico Longhini ◽  
Laura Pasin ◽  
Claudia Montagnini ◽  
Petra Konrad ◽  
Andrea Bruni ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Respiratory Rate ◽  
Randomized Clinical Trial ◽  
Protective Ventilation ◽  
Adult Patients ◽  
Control Group ◽  
Neurosurgical Procedures ◽  
Neurosurgical Patients

Abstract Background Post-operative pulmonary complications (PPC) can develop in up to 13% of patients undergoing neurosurgical procedures and may adversely affect clinical outcome. The use of intraoperative lung protective ventilation (LPV) strategies, usually including the use of a low Vt, low PEEP and low plateau pressure, seem to reduce the risk of PPC and are strongly recommended in almost all surgical procedures. Nonetheless, feasibility of LPV strategies in neurosurgical patients are still debated because the use of low Vt during LPV might result in hypercapnia with detrimental effects on cerebrovascular physiology. Aim of our study was to determine whether LPV strategies would be feasible compared with a control group in adult patients undergoing cranial or spinal surgery. Methods This single-centre, pilot randomized clinical trial was conducted at the University Hospital “Maggiore della Carità” (Novara, Italy). Adult patients undergoing major cerebral or spinal neurosurgical interventions with risk index for pulmonary post-operative complications > 2 and not expected to need post-operative intensive care unit (ICU) admission were considered eligible. Patients were randomly assigned to either LPV (Vt = 6 ml/kg of ideal body weight (IBW), respiratory rate initially set at 16 breaths/min, PEEP at 5 cmH2O and application of a recruitment manoeuvre (RM) immediately after intubation and at every disconnection from the ventilator) or control treatment (Vt = 10 ml/kg of IBW, respiratory rate initially set at 6–8 breaths/min, no PEEP and no RM). Primary outcomes of the study were intraoperative adverse events, the level of cerebral tension at dura opening and the intraoperative control of PaCO2. Secondary outcomes were the rate of pulmonary and extrapulmonary complications, the number of unplanned ICU admissions, ICU and hospital lengths of stay and mortality. Results A total of 60 patients, 30 for each group, were randomized. During brain surgery, the number of episodes of intraoperative hypercapnia and grade of cerebral tension were similar between patients randomized to receive control or LPV strategies. No difference in the rate of intraoperative adverse events was found between groups. The rate of postoperative pulmonary and extrapulmonary complications and major clinical outcomes were similar between groups. Conclusions LPV strategies in patients undergoing major neurosurgical intervention are feasible. Larger clinical trials are needed to assess their role in postoperative clinical outcome improvements. Trial registration registered on the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au), registration number ACTRN12615000707561.

scholarly journals A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions

2016 ◽  
Vol 1 (1) ◽  
pp. 19-24
Author(s):  
Hemangi S Karnik ◽  
Aparna A Nerurkar ◽  
Nishant Bawankule
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Stroke Volume ◽  
Lateral Position ◽  
Neurosurgical Procedures ◽  
Pulmonary Capillary Blood Flow ◽  
Noninvasive Cardiac Output ◽  
Neurosurgical Patients ◽  
Intraoperative Management ◽  
Pulmonary Capillary Blood

ABSTRACT Background Neurosurgical patients are operated in supine, prone, lateral, and sitting positions, which cause physiological changes in cardiorespiratory parameters. Noninvasive cardiac output (NICO) monitor developed by Novametrix Medical System Inc is a noninvasive cardiac output monitor, which also measures and displays other parameters like stroke volume, cardiac index, pulmonary capillary blood flow, alveolar and dead space ventilation, peak flow rates, airway pressures, and respiratory volumes. We felt that a study using the NICO monitor in anesthetized patients undergoing neurosurgery in different positions would quantify the cardiopulmonary changes, identify risk factors, and improve intraoperative management. Materials and methods A total of 40 consecutive patients undergoing neurosurgical procedures—20 in prone, 16 in lateral and 4 in sitting position—were studied. The hemodynamic and cardiorespiratory parameters were noted in supine position about 15 minutes after induction of general anesthesia using standard protocol and 15 minutes after giving surgical position using NICO monitor. Conclusion We conclude that under anesthesia, the prone and sitting positions negatively affect derived cardiac parameters like cardiac output, cardiac index, and stroke volume, and lateral position tends to improve these parameters while the respiratory parameters are not significantly affected. How to cite this article Karnik HS, Nerurkar AA, Bawankule N. A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions. Res Inno Anaesth 2016;1(1):19-24.

scholarly journals Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Mariateresa Giglio ◽  
Giandomenico Biancofiore ◽  
Alberto Corriero ◽  
Stefano Romagnoli ◽  
Luigi Tritapepe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Neurosurgical Procedures ◽  
Goal Directed Therapy ◽  
Number Of Patients ◽  
Risk Patients

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

Peri-operative fluid management during neurosurgical procedures

2021 ◽  
Vol 18 (2) ◽  
pp. 9-14
Author(s):  
Carlos Darcy Bersot ◽  
Rafael Linhares ◽  
Carolina Araujo Barbosa ◽  
Jose Eduardo Pereira
Keyword(s):  
Cerebral Perfusion ◽  
Cerebral Oedema ◽  
Fluid Management ◽  
Neurosurgical Procedures ◽  
Intravenous Fluids ◽  
Myocardial Depression ◽  
Haemodynamic Stability ◽  
Neurosurgical Patients ◽  
Neurological Patients ◽  
Circulating Volume

The management of fluids and electrolytes in neurosurgical patients aims to reduce the risk of cerebral oedema, reduce ICP and at the same time maintain haemodynamic stability and cerebral perfusion. Neurosurgical patients commonly receive diuretics (mannitol and furosemide), developing complications such as bleeding and diabetes insipidus. These patients may require large volumes of intravenous fluids and even blood transfusions for volume resuscitation, treatment of cerebral vasospasm, correction of preoperative dehydration or maintenance of haemodynamic stability. Goal-oriented therapy is recommended in neurological patients, with the aim of maintaining circulating volume and tolerating the changes induced by anaesthesia (vasodilation and myocardial depression).

Common Neurosurgical Procedures

2019 ◽  
pp. 1-15
Author(s):  
Kevin Hines ◽  
Stavropoula Tjoumakaris ◽  
Pascal M. Jabbour ◽  
Robert H. Rosenwasser ◽  
M. Reid Gooch
Keyword(s):  
Cervical Spine ◽  
Lumbar Spine ◽  
Adverse Events ◽  
Medical Management ◽  
Neurosurgical Procedures ◽  
Ventriculoperitoneal Shunting ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients

Medical management of the neurosurgical patient can be complicated. These patients may suffer from a difficult neurosurgical pathology while still living with challenging comorbidities. As a result, this population often requires cooperation between multiple teams including neurosurgeons, neurologists, neurointensivists, and hospitalists. In this chapter, the authors review common neurosurgical procedures that the neurohospitalist encounters, including ventriculoperitoneal shunting, craniotomy and craniectomy, cervical spine decompression with or without fusion, lumbar spine decompression and/or fusion, and cerebral angiograms. The authors aim to highlight the methodology, indications, and issues of perioperative medical management. Understanding these procedures is vital to minimizing adverse events and providing the best possible care for neurosurgical patients.

scholarly journals Leading by Example: Corporate Social Responsibility Initiatives by Dabur India Limited in North India

2020 ◽  
Vol 16 (1) ◽  
pp. 43-53
Author(s):  
Amritjot Kaur Sekhon ◽  
Lalit Mohan Kathuria
Keyword(s):  
Corporate Social Responsibility ◽  
Social Responsibility ◽  
Local Community ◽  
Secondary Data ◽  
North India ◽  
Annual Reports ◽  
Primary Data ◽  
Community Partnership ◽  
Manufacturing Plant ◽  
Corporate Social

The purpose of this study is to explore the corporate social responsibility (CSR) initiatives undertaken by Dabur India Limited, the biggest Ayurvedic company in the world, at areas close to its manufacturing plant. It also explores the perception of Dabur’s stakeholders with respect to its social responsibility behaviour. For the purpose of this study, both primary as well as secondary data have been used. The primary data have been collected by conducting unstructured interviews and a field visit within the premises of the company’s manufacturing plant in Baddi district as well as in the surrounding villages. The secondary data have been collected from annual reports of the company and the company website. On investigating, it was be observed that Dabur, through years of social involvement and local community partnership projects, has established a special bond of trust with all its stakeholders. Also, as the expenditure made by Dabur on its CSR activities has always exceeded the stipulated amount as per government recommendations, this evidently supports its dedication towards its vision statement, on creating value for society. As after a revision in CSR policies there have not been many research studies examining the CSR practices by companies in India, this study, therefore, addresses this knowledge gap and provides new insights on the compliance by Dabur with regard to new CSR guidelines by the Companies Act, 2013.

scholarly journals Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

2010 ◽  
Vol 92 (1) ◽  
pp. 56-60 ◽  
Author(s):  
K Gash ◽  
E Brown ◽  
A Pullyblank
Keyword(s):  
Clostridium Difficile ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Fulminant Colitis ◽  
Surgical Morbidity ◽  
Predisposing Factor ◽  
Number Of Patients ◽  
Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

scholarly journals SAT-176 Epidemiology of Adrenal Tumors: A Population Based Study of 1287 Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Andreas Ebbehoj ◽  
Ravinder J Kaur ◽  
Dingfeng Li ◽  
Sumitabh Singh ◽  
Catherine Zhang ◽  
...  
Keyword(s):  
Medical Records ◽  
Adrenal Mass ◽  
Local Community ◽  
Adrenal Adenoma ◽  
Population Based ◽  
Adrenal Cortical Carcinoma ◽  
Adrenal Tumors ◽  
Number Of Patients ◽  
Incidental Discovery ◽  
Work Up

Abstract Background: Adrenal tumors are reported in 5% of adults, with malignancy rates in 1–12%, and rates of overt hormonal excess in 1–15 %. However, most estimates originate from convenience samples. Our objective was to determine the incidence, prevalence and clinical presentation of adrenal tumors in a population-based setting. Methods: We used a centralized epidemiologic database to identify patients diagnosed with adrenal tumors in a local community 1995 to 2017. The database is a unique medical records linkage system that allows access to hospital and community medical records for local residents (population 137,000). We calculated incidence rates (IR) as the number of new patients diagnosed while living in the study area, and prevalence as the number of patients living in the study area on Dec 31 2017. IR and prevalence were sex- and age-adjusted to the 2010 US Census population. Results: Of 1,287 patients diagnosed with adrenal tumor, the median age of diagnosis was 62 years (IQR 52–72), 713 (55%) were women, and 13 (1%) were younger than 18 years at diagnosis. IR was highest in patients &gt;65 YO, followed by patients 40–64 YO, 18–39 YO and &lt;18 YO (142 vs 66 vs 9 vs 2 per 100,000 persons years). IR per 100,000 increased from 4.4 (CI95% 0.3–8.6) in 1995 to 47.8 (CI95% 36.9–58.7) in 2017. Overall prevalence in the population was 0.53% in 2017, ranging from 0.01% among 0–17 YO to 1.9% among +65 YO. Malignant adrenal mass was diagnosed in 8.7% patients (4 patients with adrenal cortical carcinoma (0.3%) and 108 (8.4%) patients with other malignant mass). Pheochromocytoma was diagnosed in 11 (1.1%) patients and benign adrenal mass was diagnosed in 1,175 (90.2%) patients (1,076 (83.6%) with adrenal adenoma and 85 (6.6%) with other benign mass). Median tumor size was 15 mm (range 5–255), and 184 (14%) of patients had bilateral tumors. Only 255 (20%) patients had dexamethasone suppression test, 93 (36%) with cortisol&gt;1.8 mcg/dl. Of 1,076 adrenal adenomas, 53 (4.9%) had overt hormone excess, 140 (13%) had nonfunctioning adrenal adenomas, and 88 (8.2%) had mild autonomous cortisol secretion. Hormonal work up for was incomplete in 795 (73.9%) adenomas. Patients discovered incidentally (1,050, 81.6%) had a lower rate of malignancy and hormone excess (5.3% vs 52% of patients with non-incidental discovery, p &lt;0.001). Rate of malignancy was highest in children (67% vs 8% &gt;18YO, p&lt;0.001), bilateral tumors (16% vs 8% unilateral, p&lt;0.001), tumors ≥4 cm (33% vs 7% in &lt; 4 cm, p&lt;0.001). Conclusion: IR of adrenal tumors increased 10-fold since 1995, and was highest in patients &gt;65 YO. 8.7% of tumors were malignant, with a majority represented by malignant adrenal tumors other than adrenal cortical carcinoma. The risk of malignancy was highest in non-incidental discovery, children, and tumors &gt; 4 cm. Overt hormone excess was diagnosed in 4.5% of patients. The majority of patients with adrenal adenomas had a suboptimal work up for hormone excess.

Sign in / Sign up

Export Citation Format

Share Document