Report of the AIIMS Neuroanaesthesia Update 2017, New Delhi, India

Uva Clinical Anaesthesia, 2024

The fields of neuroanaesthesia and neurocritical care have undergone substantial advancements, significantly enhancing patient outcomes and procedural efficiency. This review explores key developments, including the resurgence of ketamine for improving cerebral perfusion pressure, the adoption of dexmedetomidine for opioid-free anaesthesia, and the strategic use of adenosine and rapid ventricular pacing in neurovascular procedures. Innovations in awake craniotomies and spinal surgeries, along with the expanding role of regional anaesthesia, are highlighted. The review also discusses functional neurosurgery techniques, advanced anaesthetic management for neuronavigation and intraoperative MRI, and the implementation of enhanced recovery after surgery (ERAS) protocols. Furthermore, it addresses the evolving management strategies for stroke patients undergoing mechanical thrombectomy, traumatic brain injury, and advanced neuromonitoring techniques such as multimodal monitoring and telemetric ICP monitoring. These advancements collectively contribute to improved patient care and procedural outcomes, underscoring the importance of ongoing research and technological innovations in neuroanaesthesia and neurocritical care.

Journal of Neuroanaesthesiology and Critical Care

European Journal of Anaesthesiology, 2002

The aim of speci®c monitoring in neuroanaesthesia is to detect, as quickly as possible, intraoperative ischaemic insults so that the brain and the spinal cord may be protected from harmful and frequently inevitable events due to the type of surgery, patient positioning, haemodynamic changes or any intercurrent event. New monitors are being introduced into the operating theatre, but only a few are considered to be an absolute standard of care in neurosurgery, e.g. facial nerve monitoring for surgery of acoustic neuromas and recording of evoked potentials during repair of scoliosis. In the past decade, new monitoring devices have moved from the experimental stage to the operating theatre and although most are still in a phase of technological development and¤or de®nition of their ®eld of applicability they are being used as guides for clinical practice in those instances where cerebral well-being might be impaired. The metabolic consequences of hyperventilation, pharmacological electroencephalogram burst suppression, hypothermia, etc. can now be assessed in the operating theatre. Non-invasive monitoring is being rapidly integrated into our daily work because of its lack of secondary effects. Nevertheless, each new development is regarded as an addition rather than as a substitute for existing equipment. The perfect combination of monitors to provide essential information during an individual surgical procedure to in¯uence a better patient outcome, is still uncertain and needs extensive clinical research.

Journal of Neuroanaesthesiology and Critical Care

The coronavirus disease 2019 (COVID-19) is a major health emergency in today’s time. In December 2019, a cluster of pneumonia cases in Wuhan, China was attributed to a novel coronavirus. The World Health Organization declared it as a pandemic. As the majority of the cases suffering from COVID-19 are mildly symptomatic or asymptomatic, it becomes a great challenge to identify the infected persons in the absence of extensive testing. In the hospital environment, it can infect several other vulnerable patients and healthcare providers, significantly impacting the hospital services. Anesthesiologists are at an increased risk of COVID-19 transmission from the patients, as they are frequently involved in several aerosol-generating procedures. It is not possible to identify asymptomatic COVID-19 patients solely based on history-taking during their first point of contact with the anesthesiologists at the preanesthetic checkup clinic.Most of the neurosurgical conditions are of urgent in natu...

IntechOpen eBooks, 2023

Providing anesthesia care to neurosurgical and neurocritical care patients presents unique challenges to the anesthesiologist. Over the last century, anesthetic care for such patients has become a robustly studied field, with tools and techniques to keep patients safe and comfortable in the perioperative period. A review of the major updates and considerations for perioperative care for awake craniotomies, thrombectomy for stroke, and endoscopic neurosurgery is critical for the anesthesiologist. Additionally, newly developed enhanced recovery after surgery procedures have improved patient experiences and outcomes after both cranial and spinal neurosurgery. Finally, post-operative delirium is a major neurologic complication in elderly patients undergoing all types of procedures which all anesthesiologists should be well versed in. Here, such topics are reviewed with a focus on recent updates to the literature which are important for clinical practice.

2019

Intraoperative Neurophysiological Monitoring Reimbursement Post International Classification of Diseases-10 by Cindy Akkerman MBA, Colorado Technical University, 2006 MBA-HCM, Colorado Technical University, 2006 BA, University of Sioux Falls, 2001 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Healthcare Administration

Evidence-based Anaesthesia and Intensive Care, 2006

The practice of neuroanaesthesia is unique in that the target organ of both the surgeon and the anaesthetist is one and the same. Thus, the surgical goals have a profound impact on the constraints that the anaesthesiologist must work within. In order to appropriately anaesthetise the patient for neurosurgery, an understanding of the interrelationships of neurophysiology, pathophysiology and pharmacology is important. This chapter will review: (1) basic neurophysiological principles, (2) specific approaches to the management of intracranial pressure (ICP) as they relate to clinical neuroanaesthesia, and (3) intraoperative management of the patient with a supratentorial mass lesion.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

HE anesthetic management of neurosurgical patients is, by necessity, based upon our understanding of the physiology and pathophysiology of the central nervous system (CNS) and the effect of anesthetic agents on the CNS. Consequently, a great deal of investigative effort has been expended to elucidate the influence of anesthetics on CNS physiology and pathophysiology. The current practice of neuroanesthesia is based upon findings of these investigations. However, it should be noted that most studies in this field have been conducted in laboratory animals and the applicability of the findings to the human patient is debatable at best. A great deal of emphasis has been placed on the minor differences in anesthetic-induced changes in cerebral blood flow (CBF), cerebral metabolic rate (CMR) and intracranial pressure (ICP) that have been consistently demonstrated in a variety of studies. Is this emphasis justified? It is not surprising that, in the absence of controlled studies which demonstrate the superiority of one technique over another, interpretations of the available data differ and opinions on the optimal approach to the neurosurgical patient also differ. A more important question to the practicing anesthesiologist is not whether the minor differences in CNS physiology induced by anesthetics are relevant to all neurosurgical patients, but the identification of clinical situations in which anesthetic effects might be significant. In the present discussion, a brief review of the cerebrovascular effects of anesthetic agents will be presented. Thereafter, situations in which the anesthetic selection has been suggested to be relevant will be addressed: 1) Moderate to severe intracranial hypertension (ICH) 2) Inadequate brain relaxation during surgery 3) Evoked potential monitoring 4) Intraoperative electrocorticography 5) Cerebral protection C CN NS S e ef ff fe ec ct ts s o of f a an ne es st th he et ti ic c a ag ge en nt ts s It is now generally accepted that N 2 O is a cerebral vasodilator which can increase CBF when administered alone. This vasodilation can result in an increase in ICP. In addition, N 2 O can also increase CMR to a small extent. The simultaneous administration of iv anesthetics (barbiturates, propofol, benzodiazepines, narcotics) can substantially reduce this increase in CBF and CMR. The behaviour of a combination of volatile agents and N 2 O is quite different. When administered in low doses, volatile agents can reduce CBF and CMR. The addition of N 2 O to low dose volatile agent anesthesia increases both CBF and CMR. This N 2 O mediated vasodilation can be greater when higher doses of volatile agents are administered. Volatile agents uniformly suppress CMR. At doses of 1.5 to 2.0 minimum alveolar concentration (MAC), the commonly used agents isoflurane, desflurane and sevoflurane all produce burst suppression of the electroencephalograhy (EEG). At burst suppression, CMR is reduced by 50 to 60%. Volatile agents are also vasodilators. Their effect on CBF is biphasic. At doses of about 0.5 MAC, the suppression in CMR balances the vasodilatory effects and CBF does not change significantly. In doses greater than 1.0 MAC, the vasodilatory effect predominates and CBF increases. The addition of N 2 O to volatile-based anesthesia will increase CBF and CMR. This increase in CBF may not necessarily result in an increase in ICP. Of greater importance than changes in CBF are changes in cerebral blood volume (CBV). About 65 to 70% of intracranial blood resides in the veins and sinuses. While the effect of volatile agents on CBV parallel the CBF, these changes are of a significantly lesser magnitude. For example, sevoflurane results in a substantially lesser CBF increase than does an equivalent dose of isoflurane. However, the effect of these agents on CBV is not different. Propofol, on the other hand, reduces both CBF and CBV. Intravenous hypnotic agents, with the exception of ketamine, all decrease CMR and CBF substantially.

2005

2012

1. Controversies related to use of drugs in neuroanaesthesia: Controversies regarding the provision of anaesthesia for intracranial neurosurgery remain, with no ideal technique identified Despite the theoretical benefits of intravenous agents, volatile agents remain popular. In a study comparing desflurane, isoflurane and sevoflurane in a porcine model of intracranial hypertension, at equipotent doses and normocapnia, cerebral blood flow (CBF) and intracranial pressure (ICP) were greatest with desflurane and least with sevoflurane The same authors also confirmed that sevoflurane also caused least vasodilation In two separate studies, isoflurane was seen to impair autoregulation, although reversible with hyperventilation, while autoregulation was virtually intact with sevoflurane 1 – 1.2 % at normocapnia Although large studies may be needed, sevoflurane appears to be the most suitable volatile agent for neuroanaesthesia practice.

2014

The American Society of Neurophysiological Monitoring (ASNM) was founded in 1988 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during monitored procedures along the neuraxis. This goal is accomplished through programs in education, advocacy of basic and clinical research, and publication of guidelines. The ASNM is committed to the development of medically sound and clinically relevant guidelines for intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative monitoring were established by a committee of nearly 30 total participants and ultimately endorsed by the Board of Directors of ASNM on January 24th 2013. That document follows.

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Journal of Neuroanaesthesiology and Critical Care

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysio...

Neurocritical Care, 2019

Introduction: Neurocritical care focuses on the care of critically ill patients with an acute neurologic disorder and has grown significantly in the past few years. However, there is a lack of data that describe the scope of practice of neurointensivists and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide. To address these issues, we designed a multicenter, international, point-prevalence, cross-sectional, prospective, observational, non-interventional study in the setting of neurocritical care (PRINCE Study). Methods: In this manuscript, we analyzed data from the initial phase of the study that included registration, hospital, and intensive care unit (ICU) organizations. We present here descriptive statistics to summarize data from the registration case report form. We performed the Kruskal-Wallis test followed by the Dunn procedure to test for differences in practices among world regions. Results: We analyzed information submitted by 257 participating sites from 47 countries. The majority of those sites, 119 (46.3%), were in North America, 44 (17.2%) in Europe, 34 (13.3%) in Asia, 9 (3.5%) in the Middle East, 34 (13.3%) in Latin America, and 14 (5.5%) in Oceania. Most ICUs are from academic institutions (73.4%) located in large urban centers (44% > 1 million inhabitants). We found significant differences in hospital and ICU organization, resource allocation, and use of patient management protocols. The highest nursing/patient ratio was in Oceania (100% 1:1). Dedicated Advanced Practiced Providers are mostly present in North America (73.7%) and are uncommon in Oceania (7.7%) and the Middle East (0%). The presence of dedicated respiratory therapist is common in North America (85%), Middle East (85%), and Latin America (84%) but less common in Europe (26%) and Oceania (7.7%). The presence of dedicated pharmacist is highest in North America (89%) and Oceania (85%) and least common in Latin America (38%). The majority of respondents reported having a dedicated neuro-ICU (67% overall; highest in North America: 82%; and lowest in Oceania: 14%). Conclusion: The PRINCE Study results suggest that there is significant variability in the delivery of neurocritical care. The study also shows it is feasible to undertake international collaborations to gather global data about the practice of neurocritical care.

Journal of Neurosurgical Anesthesiology, 2020

The pandemic of coronavirus disease 2019 (COVID-19) has several implications relevant to neuroanesthesiologists, including neurologic manifestations of the disease, impact of anesthesia provision for specific neurosurgical procedures and electroconvulsive therapy, and healthcare provider wellness. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert guidance for neuroanesthesiologists during the COVID-19 pandemic. The aim of this document is to provide a focused overview of COVID-19 disease relevant to neuroanesthesia practice. This consensus statement provides information on the neurological manifestations of COVID-19, advice for neuroanesthesia clinical practice during emergent neurosurgery, interventional radiology (excluding endovascular treatment of acute ischemic stroke), transnasal neurosurgery, awake craniotomy and electroconvulsive therapy, as well as information about healthcare provider wellness. Institutions and healthcare providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.