Journal of Neurosurgical Anesthesiology

Buhl, Lauren K.; Mueller, Ariel L.; Boone, M. Dustin; Nozari, Ala

doi: 10.1097/ANA.0000000000000719pmid: 32675756

Background: Much has been written on initial airway management in patients undergoing cervical spine procedures, but comparatively less is known about extubation criteria. High cervical and occipital fusion procedures pose a particular risk for extubation given the potential for a reduced range of motion at the occiput-C1 and C1-C2 joints should reintubation be necessary. Materials and Methods: We performed a retrospective cohort analysis of posterior high cervical and occipital fusion cases to identify factors related to delayed extubation and postoperative airway and pulmonary complications. Using a convenience sample of all cases operated between January 2009 and April 2018, we reviewed anesthesia records and discharge summaries to compare patient characteristics, airway management, surgical factors, and postoperative complications between patients who underwent delayed extubation and those who did not. Results: A total of 135 patients met our inclusion criteria. Overall, 92 (68.1%) patients were extubated in the operating room (OR), and 43 (31.9%) underwent delayed extubation. Multivariate logistic regression analysis identified age, procedure length, C2 as the highest level fused, and percentage colloid administered as predictors of delayed extubation. We did not find a difference in the rate of postoperative pulmonary complications between groups (6/92 [6.5%] for OR extubation; 2/43 [4.7%] for delayed extubation). Two patients had serious airway complications, and both were extubated in the OR (2/92, 2.2%). Conclusions: The decision to extubate immediately postoperatively after high cervical and occipital fusion should be considered carefully as the morbidity associated with airway obstruction can be severe in this population, while negative effects of delayed extubation were not evident in our analysis.

Gray, Kristen; Avitsian, Rafi; Kakumanu, Saranya; Venkatraghavan, Lashmi; Chowdhury, Tumul

doi: 10.1097/ANA.0000000000000718pmid: 32658099

There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies. Much remains to be discovered on the topic of anesthesia’s effect on glioma progression.

Burbridge, Mark A.; Jaffe, Richard A.

doi: 10.1097/ANA.0000000000000714pmid: 32658101

Yoon, Sehee; Oh, Hyongmin; Yoon, Hyun-Kyu; Lee, Hyung-Chul; Park, Hee-Pyoung

doi: 10.1097/ANA.0000000000000717pmid: 32658098

Background: McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery. Methods: Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts. Results: In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation. Conclusions: Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.

Sharma, Rajeev

doi: 10.1097/ANA.0000000000000721pmid: 32740302

Selak, Tanya; Mitchell, Ruth

doi: 10.1097/ANA.0000000000000715pmid: 32658103

Hosmann, Arthur; Schnackenburg, Philipp; Rauscher, Steffen; Hopf, Andreas; Bohl, Isabelle; Engel, Adrian; Brugger, Jonas; Graf, Alexandra; Plöchl, Walter; Reinprecht, Andrea; Gruber, Andreas

doi: 10.1097/ANA.0000000000000713

Li, Jiaxin; Zhao, Yan; Yan, Xiang; Li, Ruowen; Zhang, Xingyue; Zeng, Min; Dong, Jia; Li, Shu; Peng, Yuming; Han, Ruquan

doi: 10.1097/ANA.0000000000000716pmid: 32658102

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