Medicine
Giti Dehghan Manshadi; Nina Pilehvar
Abstract
Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current ...
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Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current evidence regarding anesthesia management in elective neurosurgical procedures. Material and Methods: Two independent reviewers screened the titles and abstracts of the identified studies for eligibility. Any discrepancies were resolved through discussion and consensus. Full-text articles of potentially relevant studies were then assessed for inclusion based on the predetermined criteria. Data extraction was performed using a standardized form, including study characteristics (e.g., study design, sample size), patient demographics, type of neurosurgical procedures, anesthesia techniques, intraoperative monitoring methods, hemodynamic management strategies, pain control methods, and reported outcomes. Results: Optimal hemodynamic management was crucial in maintaining cerebral perfusion and preventing ischemic or hemorrhagic complications. Individualized blood pressure targets, guided by cerebral autoregulation monitoring or transcranial Doppler, were associated with improved outcomes compared to general blood pressure targets. Goal-directed fluid therapy, guided by stroke volume variation or cardiac output monitoring, facilitated appropriate fluid administration and reduced the risk of cerebral edema. Conclusion: This systematic review provides valuable insights into anesthesia management in elective neurosurgery. The findings suggest that tailored approaches, such as TIVA, volatile anesthetics, and balanced anesthesia, can be employed based on patient-specific factors. Intraoperative monitoring techniques, including EEG, SSEPs, MEPs, and cerebral oximetry, contribute to patient safety and guide anesthesia management.
Covid
Nina Pilehvar; Mansour Rezaei
Abstract
Intraoperative neuro-monitoring (IONM) is a crucial technique employed in neurosurgery to assess and preserve the functional integrity of the nervous system during surgical procedures. This scoping review aims to explore and summarize the existing literature on the utility of IONM in neurosurgery, focusing ...
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Intraoperative neuro-monitoring (IONM) is a crucial technique employed in neurosurgery to assess and preserve the functional integrity of the nervous system during surgical procedures. This scoping review aims to explore and summarize the existing literature on the utility of IONM in neurosurgery, focusing on its benefits, limitations, and current advancements. A comprehensive search of electronic databases was conducted, and relevant studies published between 2010 and 2023 were included. The review encompassed a wide range of neurosurgical procedures, including spinal, cranial, and peripheral nerve surgeries. The included studies predominantly focused on the application of various IONM modalities, such as somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), electromyography (EMG), electroencephalography (EEG), and brainstem auditory evoked potentials (BAEPs). The findings of this scoping review highlight the utility of IONM across different neurosurgical procedures. The use of IONM was consistently associated with a reduction in the incidence of postoperative neurological deficits, aiding in the prevention of nerve injuries and subsequent functional impairments. Furthermore, IONM was found to assist in identifying and localizing neural structures, guiding surgical approaches, and optimizing patient outcomes.
