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Journal of Neuroanaesthesiology and Critical Care
Number of Followers: 4

This is an Open Access Journal

Open Access journal
ISSN (Print) 2348-0548 - ISSN (Online) 2348-926X
Published by Thieme Publishing Group

[233 journals]

A Decade with the Journal of Neuroanaesthesiology and Critical Care
(JNACC): Reminiscing the Chronicles
- J Neuroanaesth Crit Care 2023; 10: 001-002
  DOI: 10.1055/s-0043-1768956
  
  Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
  
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  J Neuroanaesth Crit Care 2023; 10: 001-0022023-06-07T08:16:39+01:00
  Issue No: Vol. 10, No. 01 (2023)
Mentorship in Neuroanesthesia and Neurocritical Care
- J Neuroanaesth Crit Care 2022; 09: 139-141
  DOI: 10.1055/s-0043-1761219
  
  Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
  
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  J Neuroanaesth Crit Care 2022; 09: 139-1412023-01-20T06:32:10+0100
  Issue No: Vol. 09, No. 03 (2023)
Radiation Safety for Anesthesiologists and Other Personnel on Simultaneous
PET/MRI: Possible Radiation Exposure from Patients While Performing
Prolonged Duration Scans
- Authors: Nagaraj, Chandana, Joshi, Raman K., Kumar, Dinesh, R; Gopinath, Chakrabarti, Dhritiman, Singh, Pardeep K., Mangalore, Sandhya, Venkatapura, Ramesh
  Pages: 162 - 167
  Abstract: This observational study was conducted owing to the challenges of the positron emission tomography/magnetic resonance imaging (PET/MRI) that requires longer duration scanning of radiopharmaceutical injected patient and added MRI environment. The aim of this study was to assess radiation dose at different distances from the patient and the radiation burden to anesthesiologist and other personnel in performing PET/MRI under general anesthesia or sedation. First, the pre- and postscan whole body radiation exposure (WBE) from the patient were obtained for 45 minutes (n = 109) after injection of the radiopharmaceutical. The WBE was obtained at specific distances from brain (10, 30, and 100 cm) and abdomen (10 and 30cm) of patients undergoing F18 fluorodeoxyglucose PET/MRI brain or whole body studies. Second, WBE of the anesthesiologist and other staff working was separately measured using pocket dosimeters during the whole procedure. In brain scans, the mean absorbed dose rates (ADR) of prescan (45 minutes) and postscan (45 minutes) were 44.4 and 31.1 μSv at 10 cm, 14.9 and 9.7μSv at 30 cm, and 3.5 and 2.8 μSv at 100 cm, respectively, from surface of head. Similarly, it was 54.8 and 30.3 μSv at 10 cm, 23 and 13.6μSv at 30 cm, respectively, from surface of abdomen. In WB scans, the mean ADR was higher than the brain scans. Anesthesiologist exposure overall was found to be 4.84 µSv/patient/scan (112 patients). The anesthesiologist receives a safe mean effective dose in PET/MRI scanning. With good training and adequate planning, it is possible to decrease the radiation exposure to all the concerned personnel including anesthesiologists.
  Citation: J Neuroanaesth Crit Care 2022; 09: 162-167
  PubDate: 2023-01-20T06:32:04+0100
  DOI: 10.1055/s-0042-1750710
  Issue No: Vol. 09, No. 03 (2023)
Adherence to Head-of-Bed Elevation in Traumatic Brain Injury: An Audit
- Authors: Chitteti; Pragnitha, George, Ajish Sam, Nair, Shalini, Karuppasamy, Reka, Joseph, Mathew
  Pages: 177 - 182
  Abstract: Background An important factor affecting the outcome of traumatic brain injury (TBI) is the early management of raised intracranial pressure (ICP). Head-of-bed elevation (HBE) is a simple and effective method to reduce ICP and prevent aspiration in head injury. Methods This audit was carried out in a level one trauma center. All adult TBI patients were included in the study except patients who had relative contraindication to HBE, managed in prone or Trendelenburg position or who were able to be seated themselves. Patients were observed twice daily, to check adherence to HBE. Adequate HBE angle was referred as an angle of 20 to 30 degrees. A digital protractor was used to measure the head-end angle. Following the first audit cycle, after discussion with nursing staff, a bedside checklist was formulated and two postintervention audit cycles were carried out. Results The first cycle showed that 40.35% of patients had inadequate HBE. Following implementation of the checklist, this percentage dropped to 11.27 and 7.5% in the second and third cycles, respectively. Agitation (p-value = 0.038) and Glasgow coma scale at admission (p-value = 0.028) were found to be confounders for adherence to HBE. Conclusion Agitation among mild and moderate TBI patients contributed to noncompliance for HBE. There was an increasing trend in adherence to maintaining adequate HBE following the use of a bedside checklist. Sustainability of improvement was confirmed with third audit cycle.
  Citation: J Neuroanaesth Crit Care 2022; 09: 177-182
  PubDate: 2023-01-20T06:32:04+0100
  DOI: 10.1055/s-0042-1758749
  Issue No: Vol. 09, No. 03 (2023)
Indocyanine Green Administration May Cause an Exaggerated Peripheral
Oxygen Desaturation in the Presence of Liver Disease—An Underemphasized
Observation
- J Neuroanaesth Crit Care 2022; 09: 215-216
  DOI: 10.1055/s-0042-1760270
  
  Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
  
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  J Neuroanaesth Crit Care 2022; 09: 215-2162023-01-20T06:32:13+0100
  Issue No: Vol. 09, No. 03 (2023)
High-Flow Nasal Oxygen Therapy for Management of Postoperative
Pneumocephalus
- Authors: Begum; Fahmeena, Moningi, Srilata, Murthy, T Narasimha
  Abstract: Postoperative pneumocephalus (PNC) is very common in craniotomy surgeries. It can be asymptomatic or if present in more volumes can cause symptoms such as lethargy, headache, confusion, or even severe neurological deficit. Treatment of pneumocephalus with supplemental oxygen via facemask is a common neurosurgical practice. There is not much evidence of use of high-flow nasal oxygen therapy (HFNOT) for the management of PNC. Here we report a case of an 8-year-old boy with postoperative symptomatic pneumocephalus, which resolved with the application of supplemental oxygen via a high-flow nasal cannula with 30 L/min flow and FiO2 of 0.7 over 72 hours. High-flow nasal oxygen therapy can be an effective modality of treatment for postoperative PNC with added advantages of patient comfort and maintenance of warmth and moisture of the respiratory tract.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-06-14T06:59:26+01:00
  DOI: 10.1055/s-0043-1763269
Failure of Sequential Compression Device Detected by Neuromonitoring
during Minimally Invasive Posterior Scoliosis Surgery
- Authors: Raue; Kristen D., Shils, Jay, Fessler, Richard G.
  Abstract: Intraoperative neuromonitoring is recommended as standard practice for corrective scoliosis surgery. Common methods include somatosensory-evoked potentials (SSEPs) and transcranial motor-evoked potentials (TcMEPs), which have been shown to have a high diagnostic accuracy in detecting new neurological deficits postoperatively. Sequential compression devices (SCDs) are a common method for thromboprophylaxis in spine surgery and are not known to have many device-related complications. To date, there have been no reports of lower extremity ischemia secondary to SCD deflation failure detected by multimodality neuromonitoring during minimally invasive posterior spine surgery. We, therefore, present a case report of an 18-year-old male with adolescent idiopathic scoliosis who underwent minimally invasive posterior spinal fusion with instrumentation. Intraoperative decrease in SSEPs and TcMEPs were noted in the left leg shortly after incision before any instrumentation or reduction occurred. Further examination revealed that the left leg was hypoperfused compared with the right leg and that the left SCD was not properly deflating. Bilateral SCDs were removed, and perfusion and neuromonitoring returned to baseline immediately. Bilateral SCDs and the machine were replaced, and neuromonitoring remained within normal limits for the rest of the surgery. The patient had no postoperative neurologic or vascular deficits. Early detection of lower extremity ischemia by neuromonitoring resulted in the prompt identification and addressing of SCD malfunction, sparing devastating neurological and vascular injury to the patient's leg. This case reinforces the importance of neuromonitoring within spine surgery.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-05-14T18:57:33+01:00
  DOI: 10.1055/s-0043-1764297
Perioperative Outcomes of Hyperlactatemia during Craniotomy: A Systematic
Review and Meta-Analysis of 1,832 Patients
- Authors: Sharapi; Mahfouz M., Al-dardery, Nada M., El-Samahy, Mohamed A., Mahfouz, Amany E., Aljabali, Ahmed S., Ghaith, Hazem S.
  Abstract: Background Hyperlactatemia, is common in patients undergoing neurosurgical procedures. Several studies have identified potential risk factors for developing hyperlactatemia in neurosurgical patients, including body mass index, surgery duration, tumour volume, and certain drugs such as volatile anesthetic agents and corticosteroids. This systematic review and meta-analysis examined the evidence of the association between perioperative lactate levels in patients undergoing brain surgery and postoperative morbidity and mortality. Methods Using PubMed, Scopus, Web of Science, Embase, CINAHL, Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials databases, a systematic literature search was conducted for studies examining the association between perioperative hyperlactatemia and postoperative outcomes in patients undergoing brain surgery. Two authors independently evaluated the full-text papers for eligibility, and then data extraction and meta-analyses of similar studies were conducted (using a random effect model for each outcome measure). The Newcastle Ottawa Scale was used to evaluate the risk of bias (NOS scale). Results Seven observational studies were included, and a total of 1,832 patients were assessed in the systematic review and meta-analysis. The quality of the included studies ranged from poor to high quality according to the NOS quality assessment tool. Meta-analysis results revealed no significant association between perioperative hyperlactatemia and postoperative new neurological deficits (five studies: odds ratio [OR] = 0.97, 95% confidence interval [CI] [0.50–1.87], p = 0.92; heterogeneity: I 2 = 38%, p = 0.18). Similarly, perioperative hyperlactatemia was neither significantly associated with increased 30-day postoperative mortality (two studies; OR = 0.20, 95% CI [0.02–2.00], p = 0.17; heterogeneity: I 2 = 0%, p = 0.59) nor 6 months survival rate (three studies; OR = 1.05, 95% CI [0.75–1.47], p = 0.79; heterogeneity: I 2 = 0%, p = 0.51). Moreover, there was no difference in the length of hospital stay between the two groups (four studies: mean difference = –0.85, 95% CI [–1.73 to 0.03], p = 0.06). Pooled studies were not homogenous (I 2 = 68%, p = 0.03). Conclusion Perioperative hyperlactatemia is benign in neurosurgical patients and is not associated with significant postoperative outcomes, such as developing new postoperative neurological deficit, 30-day mortality, 6-month survival, or prolonged hospital stay.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-05-14T18:55:18+01:00
  DOI: 10.1055/s-0043-1767828
Intraoperative Central Diabetes Insipidus during Aneurysmal Clipping
Surgery: An Unusual Phenomenon
- Authors: Kutum; Chayanika, Khurana, Priyanka, Singh, Karandeep, Ganjoo, Pragati, Singh, Daljit
  Abstract: Central diabetes insipidus (DI) is a known complication associated with pituitary surgeries occurring in postoperative period. However, development of DI following aneurysmal subarachnoid hemorrhage (SAH) is rarely reported. We describe here a case of intraoperative DI in a patient undergoing aneurysmal clipping surgery that posed a challenge for both diagnosis and management. A 55-year-old female, diagnosed with SAH due to ruptured left middle cerebral artery (MCA) aneurysm, was posted for aneurysmal clipping. A preoperative sudden rebleeding led to neurological deterioration and patient was taken up for the evacuation of hematoma and aneurysmal clipping. Intraoperatively, 2 hours into surgery, polyuria (700–1,000 mL/hour) was noted. Arterial blood gas analysis revealed severe hypernatremia with increased serum osmolality and urine-specific gravity showed hypo-osmolar urine. Possibility of mannitol induced diuresis, overzealous administration of intravenous fluid, and other causes of DI were ruled out. Medical management of DI was initiated and after 45 minutes, urine output was reduced and serum sodium measurements showed decreasing trend indicating responsiveness to treatment. Postoperatively noncontrast computed tomography head showed temporal bleeding with MCA infarct, infarct in thalamic, and hypothalamic region with hydrocephalus. Intraoperative development of central DI was attributed to the evolving ischemic injury to the hypothalamus at the time of rebleeding that was not apparent in preoperative scan. DI resolved postoperatively after 18 hours of medical management. Development of DI during aneurysmal surgery was unexpected and unanticipated. The cause of intraoperative DI was found to be pre-existing ischemic injury of hypothalamic region that subsequently evolved to infarct which was not evident in preoperative scan. A careful observation of preoperative scans and vigilant monitoring may help in early diagnosis and management of such complication in perioperative period.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-04-24T15:08:23+01:00
  DOI: 10.1055/s-0043-1763267
Emergency Neurosurgery in a Patient with a Large Thoracic Aortic Aneurysm:
Sitting on a Bomb
- Authors: Lingareddy; Vyshnavi, Vattipalli, Sameera, Chavali, Siddharth, Kanasani, Suresh, Raju, Subodh
  Abstract: Thoracic aortic aneurysms larger than 5 cm are associated with a fatal risk of rupture, and their diagnosis is usually followed by urgent surgical repair. Other complications associated with this condition include heart failure, myocardial infarction, and stroke. Literature regarding management of these patients for emergency noncardiac surgeries is scarce, with anecdotal reports advising both surgeries in the same sitting. However, neurosurgical procedures present a unique challenge in this situation, since systemic anticoagulation may be associated with a rebleed within the cranial vault. In this case report, we present an extremely rare and challenging scenario, wherein a patient with a 6.2-cm thoracic aortic aneurysm underwent subdural hematoma evacuation prior to aneurysmal repair.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-04-24T15:05:40+01:00
  DOI: 10.1055/s-0043-1764296
Negative Pressure Pulmonary Edema after Bilateral Nasal Packing following
Transsphenoidal Pituitary Surgery for Nonfunctioning Pituitary Tumor
- Authors: Singh; Apoorva, Mahajan, Shalvi, Aghi, Shweta, Kumar, Sanjay
  Abstract: Negative pressure pulmonary edema (NPPE) is a well-known, albeit infrequent complication caused by upper airway obstruction. It may be seen after extubation following general anesthesia due to excessive negative intrathoracic pressure exerted against an obstructed upper airway. This leads to fluid extravasation from the pulmonary capillaries into the alveolar spaces and lung parenchyma. We report a case of NPPE after endoscopic transsphenoidal resection of the nonfunctional pituitary tumor, which occurred secondary to bilateral nasal packing. Reintubation and positive pressure ventilation were used to manage the patient, who was later extubated after the resolution of features of NPPE.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-04-24T15:00:53+01:00
  DOI: 10.1055/s-0043-1763265
Persistent Post-Extubation Stridor in an Intensive Care Unit: A Decision
Dilemma
- J Neuroanaesth Crit Care
  DOI: 10.1055/s-0043-1763266
  
  Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
  
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  J Neuroanaesth Crit Care ; : -2023-04-24T14:57:53+01:00
Reemergence of Neurological Deficit with Hyponatremia—When Obvious
Is Not True
- J Neuroanaesth Crit Care
  DOI: 10.1055/s-0042-1758459
  
  Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
  
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  J Neuroanaesth Crit Care ; : -2023-04-24T14:33:06+01:00
Awake Aneurysm Clipping: Challenges Conquered
- Authors: Kaur; Kirandeep, Thappa, Priya, Luthra, Ankur, Chauhan, Rajeev, Panda, Nidhi, Sahoo, Sushanta K.
  Abstract: Microsurgical aneurysm clipping under general anesthesia is considered a definitive procedure for the obliteration of unruptured and ruptured aneurysms. Aneurysm clipping can present with postoperative neurological complications, which can be missed under general anesthesia even with intraoperative neurophysiological monitoring. Real-time monitoring with awake patients can help prevent and treat these complications very early. The anesthesiologist has a vital role in awake aneurysm surgery from providing adequate surgical conditions to patient satisfaction and managing intraoperative complications. We report the first-hand experience as a neuroanesthesiology team managing awake craniotomy and aneurysm clipping.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2023-04-24T14:29:15+01:00
  DOI: 10.1055/s-0042-1760269
Awake Craniotomy for Cerebral Abscess with Pulmonary Arteriovenous
Malformation
- Authors: Shah; Saloni K., Shetty, Anita, Mehta, Dhairal
  Abstract: A cerebral abscess can be a life-threatening complication of pulmonary arteriovenous malformations (PAVM), thus posing significant morbidity if left untreated. We report a case of an incidental finding of a PAVM in a patient diagnosed with cerebral abscess. A 22-year-old male presented to the emergency department with acute onset right-sided weakness in both upper and lower limbs for 1 week. Magnetic resonance imaging showed a ring-enhancing lesion within the left parasagittal frontoparietal region s/o intracerebral abscess. High-resolution computed tomography was done as a protocol in patients posted for surgery due to coronavirus disease 2019 and coincidentally, it showed a single well-defined parenchymal nodule, 4 × 3.4 cm in the lateral basal segment of the left lower lobe. The knowledge of the pathophysiology of PAVM and expected complications during general anesthesia (GA) and positive pressure mechanical ventilation is essential. In such conditions, awake craniotomy under conscious sedation and scalp block may be considered as an alternative to GA.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2022-12-17T16:51:33+0100
  DOI: 10.1055/s-0042-1756432
Comparison of Monitored Anesthesia Care with Propofol Versus
Dexmedetomidine for Awake Craniotomy: A Retrospective study
- Authors: Thakkar; Keta, Mariappan, Ramamani, Prabhu, Krishna, Yadav, Bijesh, Singh, Georgene
  Abstract: Background Anesthetic agents used for awake craniotomy should be safe, short-acting, titratable, and provide an adequate level of sedation and analgesia, along with facilitating adequate neurological assessment during the functional testing. Our study aims to review the efficacy and safety profile, along with the potential for neurophysiological monitoring, of two commonly used anesthetic regimens, i.e., propofol and dexmedetomidine. Methods After the Ethics Committee approval, a retrospective analysis of 51 patients who underwent awake craniotomy for brain tumor excision over a period of 7 years was done. Those who received monitored anesthesia care (MAC) were divided into two groups, namely, Group P for that received propofol, and Group D that received dexmedetomidine and their hemodynamic profile, perioperative complications, neuromonitoring techniques, and postoperative course was noted from the records. Results A total of 31 patients were administered MAC with propofol and 20 with dexmedetomidine. The baseline demographic data, duration of surgery, intensive care unit (ICU), and hospital stay were comparable between the two. The hemodynamic profile as assessed by the heart rate and blood pressure was also comparable. The incidence of intraoperative seizures was found to be less in Group P, though. Episodes of transient desaturation were observed more in Group P (9.7%) than in Group D (5%), but none of the patients required conversion to general anesthesia. Direct cortical stimulation was satisfactorily elicited in 80% in Group P and 85% in Group D. Conclusions MAC with propofol and dexmedetomidine are acceptable techniques with comparable hemodynamic profile, intraoperative and postoperative complications, and potential for neurophysiological monitoring.
  Citation: J Neuroanaesth Crit Care ; : -
  PubDate: 2022-07-25T22:07:40+01:00
  DOI: 10.1055/s-0042-1748195