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Neurosurgery: Posterior fossa surgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Geriatric patients represent a complex subset of patients in view of their ageing physiology, multiple comorbidities, polypharmacy, cognitive dysfunction, geriatric syndromes (including frailty) and unpredictable life expectancy (2). Consequently, surgical options in this patient population have historically been fraught with an increased risk of perioperative morbidity and mortality. However, relief of debilitating or life-threatening neurological symptoms is also important to attain a better quality of life or to maintain an acceptable level of functioning in patients suffering from posterior fossa pathology. Moreover, development of newer minimally invasive neurosurgical techniques, better neurocritical care and advancing technology in the field of neuroanesthesia has led to refinement of neurosurgical practice in recent times. All these aspects have led to an increase in the number and variety of cases that are now being considered amenable to surgical management in geriatric population, with considerable ease and safety.
Pain management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
One of the most important functions of a neurocritical care unit is to provide dedicated monitoring of neurologic function. While the continuous reporting of vital signs is a standard function of any ICU, the attention to a patient’s mental state, cranial nerve function, and motor and sensory examinations is unique to neurocritical care. This becomes most important for patients who require analgesic therapy, especially in the form of opioids. Since sedation can be an early warning sign of impending neurologic catastrophe, such as brain herniation, medications with sedative properties, such as opioids, may impair the clinician’s ability to detect and prevent neurologic deterioration. Commonly used sedation scales in the ICU include the Glasgow Coma Scale and the Ramsay Sedation Scale, although many other validated scales are available, even at the institutional level. Regardless of the scale, the most important factor for the safe delivery of opioids to patients with neurologic injury is the frequent assessment of mental status, by any means available.
Basic principles of neurointensive care
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
The critically ill patient with a primary neurologic disorder is best managed in a neurocritical care unit. The specialized care provides an interface between the brain and the various other organ systems of the body while catering to the unique requirements of a deranged physiology.
Development and validation of a RASS-related nomogram to predict the in-hospital mortality of neurocritical patients: a retrospective analysis based on the MIMIC-IV clinical database
Published in Current Medical Research and Opinion, 2022
Shenyan Gu, Yuqin Wang, Kaifu Ke, Xin Tong, Jiahui Gu, Yuanyuan Zhang
Neurocritical care is an emerging and rapidly developing subspecialty of neurology, which mainly combines neurology with critical care medicine and provides high-quality medical care and treatment for neurocritical patients. Patients admitted into the neurologic intensive care unit (NICU) are often accompanied by critical conditions such as disturbance of consciousness, paralysis, fever, infection, and ventilation dependence, with high mortality during hospitalization. Studies have shown that neurocritical patients account for approximately 10–25%1–3 of critically ill patients requiring intensive care and the in-hospital mortality rate of neurocritical patients is about 11–27%3–6 in various countries. Neurocritical illnesses are costly, resource-demanding, and poor-prognosis diseases1 that place a heavy burden on global health care systems, especially the neurocritical care.
The prediction value of Glasgow coma scale-pupils score in neurocritical patients: a retrospective study
Published in Brain Injury, 2021
Yingxin Lin, Sheng Zhang, Weixing Zhang, Xinxin Wang, Lei Huang, Hua Luo
Neurocritical illnesses are resource-demanding and consuming diseases associated with unfavorable outcomes. Clinical judgments and decisions are made based on interpretation by observations and measurements of clinical conditions. Decisions such as whether to continue aggressive neurointensive care or long-term support address importance on prognosis for short-term mortality and prolonged disability. Nowadays many complex mathematic models by integrating information from vital signs, biomarkers, electrophysiology findings, neuroimaging techniques, and even genomics have been profoundly studied, however, most of these are not yet ready to be applied in clinical setting. Varieties between different neurological diseases and between available variables, scores, and scales make prognosis assessment in neurocritical care even more difficult. A prediction model, which is simple and universal but with sufficient statistical performance to guide decision making is needed.
Designing undergraduate neurosurgical e-learning: medical students’ perspective
Published in British Journal of Neurosurgery, 2019
C. Burford, A. Guni, K. Rajan, J. Hanrahan, M. Armitage, A. Driscoll, C. Southey, J. H. Moon, A. S. Pandit
These e-modules meet several of the neurosurgical educational needs that Knight et al. identify. For example, on head injuries, our e-module includes a virtual case of a patient with en extradural haemorrhage to illustrate principles of raised ICP. We explored some serious, but often late, ‘red flag’ signs of raised ICP such as papilloedema and third nerve palsy, and used interactive diagrams to explain underlying physiological concepts. We explained the role of neurocritical care in the management of neurosurgical patients, similar to the neurointensive care unit session carried out by Knight et al, along with the appropriate timing for operative management. This learning was reinforced with multiple-choice questions. Pilot data, collected by pre- and post-module electronic questionnaire, from 14 students showed a significant improvement in the pre- (60%) and post-module (83%) scores (p < 0.001). The eModules were also rated highly by students, on a 0–10 scale, in terms of enjoyment (7.7), clinical usefulness (8.7) and as an aid to learning anatomy (9.1).2