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  • 1
    Online Resource
    Online Resource
    Patient, Surgeon, and Anesthesiologist Satisfaction: Who has the Priority?
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Neurosurgical Anesthesiology Vol. 30, No. 2 ( 2018-04), p. 191-193
    Details
    In: Journal of Neurosurgical Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 2 ( 2018-04), p. 191-193
    Type of Medium: Online Resource
    ISSN: 0898-4921
    URL: Article
    DOI: 10.1097/ANA.0000000000000488
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2047474-X
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  • 2
    Online Resource
    Online Resource
    Determining the Upper and Lower Limits of Cerebral Autoregulation With Cerebral Oximetry Autoregulation Curves: A Case Series
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Critical Care Medicine Vol. 46, No. 5 ( 2018-05), p. e473-e477
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 5 ( 2018-05), p. e473-e477
    Abstract: Critical care guidelines recommend a single target value for mean arterial blood pressure in critically ill patients. However, growing evidence regarding cerebral autoregulation challenges this concept and supports individualizing mean arterial blood pressure targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation derived from near-infrared spectroscopy is an acceptable surrogate for cerebral blood flow and has been validated to measure cerebral autoregulation. This study suggests a novel mechanism to construct autoregulation curves based on near-infrared spectroscopy–measured cerebral oximetry. Design: Case-series study. Setting: Neurocritical care unit in a tertiary medical center. Patients: Patients with acute neurologic injury and Glasgow coma scale score less than or equal to 8. Measurements and Main Results: Autoregulation curves were plotted using the fractional-polynomial model in Stata after multimodal continuous monitoring of regional cerebral oxygen saturation and mean arterial blood pressure. Individualized autoregulation curves of seven patients exhibited varying upper and lower limits of autoregulation and provided useful clinical information on the autoregulation trend (curves moving to the right or left during the acute coma period). The median lower and upper limits of autoregulation were 86.5 mm Hg (interquartile range, 74–93.5) and 93.5 mm Hg (interquartile range, 83–99), respectively. Conclusions: This case-series study showed feasibility of delineating real trends of the cerebral autoregulation plateau and direct visualization of the cerebral autoregulation curve after at least 24 hours of recording without manipulation of mean arterial blood pressure by external stimuli. The integration of multimodal monitoring at the bedside with cerebral oximetry provides a noninvasive method to delineate daily individual cerebral autoregulation curves.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000003012
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2034247-0
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  • 3
    Online Resource
    Online Resource
    A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery: A Meta-Analysis of Randomized Studies
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Neurosurgical Anesthesiology Vol. 29, No. 4 ( 2017-10), p. 415-425
    Details
    In: Journal of Neurosurgical Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 4 ( 2017-10), p. 415-425
    Abstract: General anesthesia (GA) is commonly used for lumbar spine surgery. The advantages of regional anesthesia (RA) for lumbar spine surgery, as compared with GA, remain unclear. The aim of this meta-analysis was to determine the impact of the type of anesthesia on intraoperative events, incidence of postoperative complications, and recovery time of patients undergoing lumbar spine surgery. Methods: Major databases (PubMed, EMBASE, Cochrane library, ISI Web of Science, and Google Scholar) were systematically searched for randomized clinical trials comparing regional versus GA for lumbar spine surgery. Study-level characteristics, intraoperative events, and postoperative complications were extracted from the articles. Meta-analysis was performed using random-effect models. Results: Fifteen randomized clinical trials comprising 961 patients were included in this meta-analysis. The use of RA for lumbar spine surgery was significantly associated with lower incidence of postoperative nausea and vomiting at 24 hours (risk ratio [RR]=0.42; 95% confidence interval [CI] =0.23-0.77, P =0.005), as well as lower length of stay (standardized mean difference [SMD]=−0.73; 95% CI=−1.17 to −0.29, P =0.001) and intraoperative blood loss (SMD=−1.24; 95% CI=−2.27 to −0.21, P =0.02). There was no statistically significant association with lower pain score (SMD=−0.47; 95% CI=−2.13 to 1.19, P =0.58), lower incidence of urinary retention (RR=1.16; 95% CI=0.73-1.86, P =0.53) or analgesic requirement (RR=0.87; 95% CI=0.64-1.18, P =0.37). Conclusions: In summary, RA has several advantageous characteristics, including lower incidence of postoperative nausea and vomiting, length of stay, and blood loss. Further well-designed studies with more sample size are needed to clarify the associations with possible neurological complications.
    Type of Medium: Online Resource
    ISSN: 0898-4921
    URL: Article
    DOI: 10.1097/ANA.0000000000000362
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2047474-X
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  • 4
    Online Resource
    Online Resource
    Optimizing Mean Arterial Pressure in Acutely Comatose Patients Using Cerebral Autoregulation Multimodal Monitoring With Near-Infrared Spectroscopy*
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Critical Care Medicine Vol. 47, No. 10 ( 2019-10), p. 1409-1415
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 10 ( 2019-10), p. 1409-1415
    Abstract: This study investigated whether comatose patients with greater duration and magnitude of clinically observed mean arterial pressure outside optimal mean arterial blood pressure have worse outcomes than those with mean arterial blood pressure closer to optimal mean arterial blood pressure calculated by bedside multimodal cerebral autoregulation monitoring using near-infrared spectroscopy. Design: Prospective observational study. Setting: Neurocritical Care Unit of the Johns Hopkins Hospital. Subjects: Acutely comatose patients secondary to brain injury. Interventions: None. Measurements and Main Results: The cerebral oximetry index was continuously monitored with near-infrared spectroscopy for up to 3 days. Optimal mean arterial blood pressure was defined as that mean arterial blood pressure at the lowest cerebral oximetry index (nadir index) for each 24-hour period of monitoring. Kaplan-Meier analysis and proportional hazard regression models were used to determine if survival at 3 months was associated with a shorter duration of mean arterial blood pressure outside optimal mean arterial blood pressure and the absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure. A total 91 comatose patients were enrolled in the study. The most common etiology was intracerebral hemorrhage. Optimal mean arterial blood pressure could be calculated in 89 patients (97%), and the median optimal mean arterial blood pressure was 89.7 mm Hg (84.6–100 mm Hg). In multivariate proportional hazard analysis, duration outside optimal mean arterial blood pressure of greater than 80% of monitoring time (adjusted hazard ratio, 2.13; 95% CI, 1.04–4.41; p = 0.04) and absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure of more than 10 mm Hg (adjusted hazard ratio, 2.44; 95% CI, 1.21–4.92; p = 0.013) were independently associated with mortality at 3 months, after adjusting for brain herniation, admission Glasgow Coma Scale, duration on vasopressors and midline shift at septum. Conclusions: Comatose neurocritically ill adults with an absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure greater than 10 mm Hg and duration outside optimal mean arterial blood pressure greater than 80% had increased mortality at 3 months. Noninvasive near-infrared spectroscopy-based bedside calculation of optimal mean arterial blood pressure is feasible and might be a promising tool for cerebral autoregulation oriented-therapy in neurocritical care patients.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000003908
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2034247-0
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  • 5
    Online Resource
    Online Resource
    Cerebral Autoregulation-oriented Therapy at the Bedside
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesiology Vol. 126, No. 6 ( 2017-06-01), p. 1187-1199
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 126, No. 6 ( 2017-06-01), p. 1187-1199
    Abstract: This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes. Six of these nine studies (66%) showed that patients for whom median cerebral perfusion pressure or mean arterial blood pressure differed significantly from the optimum, defined by cerebral autoregulation monitoring, were more likely to have an unfavorable outcome. The evidence indicates that monitoring of continuous cerebral autoregulation at the bedside is feasible and has the potential to be used to direct blood pressure management in acutely ill patients.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001625
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2016092-6
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  • 6
    Online Resource
    Online Resource
    Relation entre les mesures de l’indice bispectral de profondeur de l’anesthésie et la mortalité postopératoire: méta-analyse des études observationnelles
    Springer Science and Business Media LLC ; 2017
    In:  Canadian Journal of Anesthesia/Journal canadien d'anesthésie Vol. 64, No. 6 ( 2017-6), p. 597-607
    Details
    In: Canadian Journal of Anesthesia/Journal canadien d'anesthésie, Springer Science and Business Media LLC, Vol. 64, No. 6 ( 2017-6), p. 597-607
    Type of Medium: Online Resource
    ISSN: 0832-610X , 1496-8975
    URL: Article
    DOI: 10.1007/s12630-017-0872-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2050416-0
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  • 7
    Online Resource
    Online Resource
    Glasgow Coma Scale Score Fluctuations are Inversely Associated With a NIRS-based Index of Cerebral Autoregulation in Acutely Comatose Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Neurosurgical Anesthesiology Vol. 31, No. 3 ( 2019-07), p. 306-310
    Details
    In: Journal of Neurosurgical Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 3 ( 2019-07), p. 306-310
    Abstract: The Glasgow Coma Scale (GCS) is an essential coma scale in critical care for determining the neurological status of patients and for estimating their long-term prognosis. Similarly, cerebral autoregulation (CA) monitoring has shown to be an accurate technique for predicting clinical outcomes. However, little is known about the relationship between CA measurements and GCS scores among neurological critically ill patients. This study aimed to explore the association between noninvasive CA multimodal monitoring measurements and GCS scores. Methods: Acutely comatose patients with a variety of neurological injuries admitted to a neurocritical care unit were monitored using near-infrared spectroscopy–based multimodal monitoring for up to 72 hours. Regional cerebral oxygen saturation (rScO 2 ), cerebral oximetry index (COx), GCS, and GCS motor data were measured hourly. COx was calculated as a Pearson correlation coefficient between low-frequency changes in rScO 2 and mean arterial pressure. Mixed random effects models with random intercept was used to determine the relationship between hourly near-infrared spectroscopy–based measurements and GCS or GCS motor scores. Results: A total of 871 observations (h) were analyzed from 57 patients with a variety of neurological conditions. Mean age was 58.7±14.2 years and the male to female ratio was 1:1.3. After adjusting for hemoglobin and partial pressure of carbon dioxide in arterial blood, COx was inversely associated with GCS (β=−1.12, 95% confidence interval [CI], −1.94 to −0.31, P =0.007) and GCS motor score (β=−1.06, 95% CI, −2.10 to −0.04, P =0.04). In contrast rScO 2 was not associated with GCS (β=−0.002, 95% CI, −0.01 to 0.01, P =0.76) or GCS motor score (β=−0.001, 95% CI, −0.01 to 0.01, P =0.84). Conclusions: This study showed that fluctuations in GCS scores are inversely associated with fluctuations in COx; as COx increases (impaired autoregulation), more severe neurological impairment is observed. However, the difference in COx between high and low GCS is small and warrants further studies investigating this association. CA multimodal monitoring with COx may have the potential to be used as a surrogate of neurological status when the neurological examination is not reliable (ie, sedation and paralytic drug administration).
    Type of Medium: Online Resource
    ISSN: 0898-4921
    URL: Article
    DOI: 10.1097/ANA.0000000000000513
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2047474-X
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  • 8
    Online Resource
    Online Resource
    Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis
    Edizioni Minerva Medica ; 2018
    In:  Minerva Anestesiologica Vol. 84, No. 3 ( 2018-04)
    Details
    In: Minerva Anestesiologica, Edizioni Minerva Medica, Vol. 84, No. 3 ( 2018-04)
    Type of Medium: Online Resource
    ISSN: 0375-9393 , 1827-1596
    URL: Article
    DOI: 10.23736/S0375-9393.17.11920-6
    Language: English
    Publisher: Edizioni Minerva Medica
    Publication Date: 2018
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