Effect of glycemic control on outcomes after aneurysmal subarachnoid hemorrhage: A comprehensive analysis of stress-induced hyperglycemia and chronic glycemic status.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) frequently precipitates stress-induced hyperglycemia, yet the relationship between baseline glycemic control and clinical outcomes remains poorly understood. This study investigates the association between glycosylated hemoglobin (HbA1c) levels and clinical outcomes in aSAH patients, with a particular focus on stress-induced hyperglycemia(SIH) patterns.

Methods: This prospective observational study enrolled 155 consecutive aSAH patients aged ≥ 18 years.

The Effect of Total Intravenous Anesthesia and Inhalational Anesthesia on the Markers of Neuronal and Systemic Inflammation in Patients Undergoing Resection of Supratentorial Gliomas (TINSI Trial): Study Protocol for a Randomized Controlled Trial.

Brain tumors and craniotomy surgeries can induce both systemic and neuronal inflammation. Currently, there is a limited amount of literature addressing the influence of anesthetic agents on neuronal and systemic inflammation in neurosurgical settings and its impact on the occurrence of postoperative neurocognitive dysfunction (PND). Our primary objective is to assess the effects of propofol-based total intravenous anesthesia (TIVA) compared to sevoflurane inhalational anesthesia (INHA) with respect to the levels of perioperative inflammatory markers, specifically neuron-specific enolase (NSE) and interleukin-6 (IL-6) in patients undergoing craniotomy for supratentorial tumor surgery.

A prospective observational study to compare and evaluate delta down, aortic velocity time integral variability, and superior vena cava collapsibility index as predictors of fluid responsiveness in patients with supratentorial brain tumors undergoing elective neurosurgery.

Background: Patients undergoing surgical resection of brain tumors frequently exhibit a spectrum of hemodynamic fluctuations necessitating careful fluid management. This study aimed to evaluate the feasibility of dynamic predictors of fluid responsiveness, such as delta down (DD), aortic velocity time integral variability (VTIAoV), and superior vena cava collapsibility index (SVCCI), in patients undergoing neurosurgery for brain tumors.

Methods: In this prospective study, 30 patients scheduled to undergo elective neurosurgery for brain tumor resection were enrolled.

Periprocedural management of patients presenting for neurointerventional procedures using flow diverters for complex intracranial aneurysms: An anesthetist's perspective - A narrative review.

Complex intracranial aneurysms pose significant challenges in the realm of neurointervention, necessitating meticulous planning and execution. This article highlights the crucial roles played by anesthetists in these procedures, including patient assessment, anesthesia planning, and continuous monitoring and maintaining hemodynamic stability, which are pivotal in optimizing patient safety. Understanding these complex procedures and their complications will aid the anesthetist in delivering optimal care and in foreseeing and managing the potential associated complications.

Evaluation of markers of cerebral oxygenation and metabolism in patients undergoing clipping of cerebral aneurysm under total intravenous anesthesia versus inhalational anesthesia: A prospective randomized trial (COM-IVIN trial).

Introduction: Anesthetic goals in patients undergoing clipping of cerebral aneurysm include maintenance of cerebral blood flow, oxygenation, and metabolism to avoid cerebral ischemia and maintenance of hemodynamic stability. We intend to study the influence of anesthetic agents on the outcome of aneurysmal subarachnoid hemorrhage (SAH).

Materials And Methods: This is a prospective, randomized, parallel, single-center pilot trial approved by the Institutional Ethics Committee and is prospectively registered with the Clinical Trial Registry of India.

A prospective-randomized placebo-controlled trial comparing the effects of nebulized dexmedetomidine v/s dexmedetomidine-lignocaine mixture on intraoperative hemodynamics and surgical field quality in patients undergoing endoscopic transnasal transsphenoidal pituitary tumor surgery.

Background: During transnasal transsphenoidal pituitary surgery (TNTSS), the primary objective is to maintain stable hemodynamics while ensuring ideal surgical conditions. This study aimed to investigate the effect of nebulized dexmedetomidine on hemodynamic parameters and the quality of the surgical field during TNTSS.

Methods: Seventy-five patients scheduled for TNTSS were randomized into three groups of 25 each and received preoperative nebulization with 5 mL of nebulizing fluid consisting of 1.

Evaluation and correlation of nociceptive response index and spectral entropy indices as monitors of nociception in anesthetized patients.

Objectives: During anesthesia, the response to these stimuli depends on the balance between nociception and antinociception. Recently, various monitoring systems based on the variables derived from electroencephalography, plethysmography, autonomic tone, reflex pathways, and composite algorithms have been introduced for monitoring nociception. The main aim of our study was to evaluate and correlate the physiological variables which reflect the autonomic nervous system response to nociception, such as heart rate (HR), systolic blood pressure (SBP), perfusion index (PI), and nociceptive response index (NRI), with the spectral entropy indices response entropy (RE) and RE-state entropy (SE), which reflects electromyographic (EMG) activation as a response to pain.

A Perfusion Index-Based Evaluation and Comparison of Peripheral Perfusion in Sevoflurane and Isoflurane Anaesthesia: A Prospective Randomised Controlled Trial.

Objective: Perfusion index has shown to be helpful in the operative and critical care settings to monitor peripheral tissue perfusion. Randomised controlled trials quantifying different agents' vasodilatory properties using perfusion index has been limited. Therefore, we undertook this study to compare the vasodilatory effects of isoflurane and sevoflurane using perfusion index.

Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors.

Objectives: A wide variety of electrocardiographic (ECG) changes has been described in the context of neurological catastrophe. There has been diverse and plentiful literature emphasizing the cardiac changes in acute cerebrovascular events and traumatic brain injury. In stark contrast, there is scarce literature on the incidence of cardiac dysfunction caused by raised intracranial pressure (ICP) resulting from brain tumors.

An Entropy-Based Prospective Randomized Controlled Trial to Evaluate the Analgesic and Hypnotic Effects of Equipotent Doses of Sevoflurane and Isoflurane in Patients Presenting for Spine Surgeries.

 Minimal alveolar concentration (MAC) of anesthetic agents has been considered a suitable measure of the potency of inhalational anesthetics. Furthermore, it is assumed that equi-MAC concentrations of different anesthetic agents have a similar potency in suppressing responses to painful stimuli. Isoflurane and sevoflurane are two commonly used volatile anesthetic agents in spine surgeries.

Anesthetic Management of a Patient With Arterial Tortuosity Syndrome Undergoing Cerebral Revascularization Surgery-A Case Report.

Arterial tortuosity syndrome is a rare hereditary autosomal recessive connective tissue disorder characterized by elongation and tortuosity of the large- and medium-sized arteries. We present the case of a 13-year old child with arterial tortuosity syndrome who underwent occipital encephaloduroarteriomyosynangiosis for posterior circulation insufficiency. The constellation of clinical features in our patient portended significant anesthetic concerns, including difficult airway due to craniofacial abnormalities, risk of stroke, and myocardial infarction due to intracerebral and coronary arterial tortuosity and stenosis.

A Comparative Study to Evaluate the Efficacy of Virtual Versus Direct Airway Assessment in the Preoperative Period in Patients Presenting for Neurosurgery: A Quest for Safer Preoperative Practice in Neuroanesthesia in the Backdrop of the COVID-19 Pandemic!

 Neurosurgical patients with cervical spine pathologies, craniofacial and craniovertebral junction anomalies, recurrent cervical spine, and posterior fossa surgeries frequently present with an airway that is anticipated to be difficult. Although the routine physical evaluation is nonaerosol-generating, Mallampati scoring, mouth opening, and assessment of lower cranial nerve function could potentially generate aerosols, imposing a greater risk of acquiring severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. Moreover, airway evaluation requires the patient to remove the mask, thereby posing a greater risk to the assessing anesthesiologist.

A Rare Case of Rhinocerebral Mucormycosis Presenting as Garcin Syndrome and Acute Ischemic Stroke.

Background: Mucormycosis is a rare fungal infection affecting immunocompromised patients, with the rhinocerebral variant as the most common presentation. Garcin syndrome is the progressive involvement of the cranial nerves resulting in total unilateral paralysis of cranial nerves, absence of sensory or motor deficits, and not associated with features of raised intracranial pressure. We report a case of invasive rhinocerebral mucormycosis presenting as Garcin syndrome and acute ischemic stroke.

Emergency neurological procedures during COVID-19 pandemic: Practical issues.

The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. A significant number of these patients would present to hospitals with neurological manifestations and neurosurgical emergencies requiring urgent treatment. The anesthesiologists should be prepared to manage these cases in an efficient and timely manner in the operating room, intensive care units, and interventional neuroradiology suites.

Perioperative Analgesia in Neurosurgery (PAIN): A national survey of pain assessment and management among neuroanesthesiologists of India.

Background: Perioperative pain assessment and management in neurosurgical patients varies widely across the globe. There is lack of data from developing world regarding practices of pain assessment and management in neurosurgical population. This survey aimed to capture practices and perceptions regarding perioperative pain assessment and management in neurosurgical patients among anesthesiologists who are members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) and evaluated if hospital and pain characteristics predicted the use of structured pain assessment protocol and use of opioids for postoperative pain management.

Role of Multimodal Cerebral Oximetry Monitoring in the Anesthetic Management of a Patient With High-Grade Intracranial Arteriovenous Malformation: A Case Report.

Near-infrared spectroscopy (NIRS) is a noninvasive monitor of regional brain tissue oxygenation, and jugular venous oximetry (SjvO2) is a monitor of global cerebral oxygenation. We report the role of intraoperative multimodal monitoring of cerebral oxygenation in the anesthetic management of a patient with grade III intracranial arteriovenous malformation (AVM) presenting for surgical excision. Real-time monitoring of cerebral oxygenation is of much relevance in high-grade AVMs where anesthetic management is focused on neuroprotection and prevention of cerebral hypoxia.

Effect of Low-Dose Dexmedetomidine on the Anesthetic and Recovery Profile of Sevoflurane-Based Anesthesia in Patients Presenting for Supratentorial Neurosurgeries: A Randomized Double-Blind Placebo-Controlled Trial.

 Dexmedetomidine could be a suitable adjuvant in neuroanesthesia due to its analgesic and anesthetic-sparing properties with the added advantage of facilitating intraoperative neuromonitoring. However, its recovery profile is still debated upon, as in neuroanesthesia, a prompt recovery is essential for postoperative neurologic assessment. We designed this study to evaluate the effect of dexmedetomidine on the anesthetic and recovery profile of patients presenting for supratentorial neurosurgeries.

Multimodal monitoring to aid detection and management of intraoperative seizures: a case report.

One of the primary goals in Neuroanesthesia is to preserve cerebral oxygenation and protect the brain from secondary injuries. Seizures have severe implications in the intraoperative period, as it can instigate an increase in cerebral metabolism and oxygen demand, thus causing cerebral hypoxia. Detection of intraoperative seizures is imperative in neurosurgical cases as the ramifications of intracranial hypertension and cerebral hypoxia caused by it can affect patient prognosis and perioperative outcomes.

A Case of Transposition of Great Arteries with Ventricular Septal Defect and Mesocardia Presenting for Neurosurgery.

Congenitally corrected transposition of great arteries (CC-TGAs) associated with a ventricular septal defect (VSD) presents with cyanotic spells and systemic complications such as brain abscess. In mesocardia, the heart lies in the midline with no apex seen on the left side. We report the anesthetic management of a child with CC-TGA, VSD, and mesocardia presenting with parietal brain abscess for neurosurgery.