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1. Perioperative Hypothermia (33°C) Does Not Increase the Occurrence of Cardiovascular Events in Patients Undergoing Cerebral Aneurysm Surgery

Author

D. Chartrand, Michael Beven, C. Salem, W. Burnett, S. Jackson, G. Downey, Michael T. Lawton, S. Lownie, R. Tack, E. Dy, Tord D. Alden, David R. McIlroy, Lis Evered, K. Lukitto, L. Kirby, Thomas A. Moore, R. Popovic, N. Robertson, Patrick W. Hitchon, A. Ashtari, R. Elbe, N. F. Kassell, D. Dulli, A. Wyss, G. Ghazali, S. Rice, Gavin W. Britz, P. Bennett, Karen B. Domino, A. Shahen, D. Dehring, Robert Greif, Argye E. Hillis, L. Meng, D. Fishback, Fred Gentili, Mark Buckland, B. Schaefer, H. Madder, C. Weasler, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Basil F. Matta, Kevin H. Siu, H. Machlin, W. Pfisterer, A. Freymuth, N. Badner, R. Wilson, R. Grauer, Zhiyi Zuo, A. McAllister, Z. Sha, A. Rushton, D. Hill, William T. Clarke, L. Jensen, G. Heard, L. Clark, D. Chatfield, J. Haartsen, Jing Wang, S. Nobles, Renee Testa, P. D'Urso, Hossam El-Beheiry, David J. Stone, James C. Torner, Michael J. Souter, A. Meyer, Marek A. Mirski, Marlan R. Hansen, W. Jenkins, L. Pobereskin, J. Walkes, M. Quigley, R. Struthers, James H McMahon, Howard A. Riina, Behnam Badie, P. Heppner, Simon Jones, R. Silbergleit, Thomas N. Pajewski, T. Broderick, Katherine Harris, P. Smythe, N. Duggal, J. Quaedackers, J. Mason, P. E. Bickler, P. McNeill, V. Roelfsema, I. Gibmeier, C. Chambers, H. Gramke, D. Campbell, T. Novick, O. Moise, J. Woletz, Lorri A. Lee, H. Van Aken, Adrian W. Gelb, A. Kane, B. Rapf, Martin S. Angst, S. Shaikh, D. Sirhan, C. Miller, B. Hodkinson, D. Leggett, F. Johnson, Harry J. M. Lemmens, M. Langley, Y. Young, Jeffrey V. Rosenfeld, C. Moy, W. Hamm, C. Hall, G. Henry, R. Burnstein, Lisa Hannegan, A. Buchmann, R. Schatzer, Bruce P. Hermann, John E. McGillicuddy, Bruno Giordani, John C. VanGilder, Keith H. Berge, D. Sage, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, T. Hartman, Laurel E. Moore, S. Bhatia, Richard A. Jaffe, G. Seever, D. Cowie, Jonathan G. Zaroff, C. Duffy, Deborah A. Rusy, Elana Farace, H R Winn, Paul H. Ting, R. Spinka, J. Marler, Patricia H. Petrozza, S. Harding, Lauren C. Berkow, E. Cunningham, D. Bisnaire, D. Wilhite, P. Blanton, S. Laurent, O. Odukoya, Issam A. Awad, P. Chery, C. Lind, B. Bauer, D. Lindholm, K. Kieburtz, J. Ormrod, Michael P. Murphy, Timothy G. Short, Y. Painchaud, R. Peters, Peter C. Whitfield, D. Bain, B. Hindman, A. Shelton, A. Morris, D. Milovan, L. Salvia, William L. Young, S. Wallace, W. Lilley, H. Yi, R. Chelliah, David W. Newell, R. Deam, John Laidlaw, P. Mak, J. Woelfer, K. Graves, Peter M. C. Wright, D. Van Alstine, M. Hemstreet, Phillip A. Scott, Steven D. Chang, S. Poustie, M. Clausen, I. Herrick, Daniel H. Kim, Vladimir Zelman, John L.D. Atkinson, Marcel E. Durieux, Alessandro Olivi, G. Smith, James R. Munis, F. Vasarhelyi, S. Olson, C. Greiner, C. Hoenemann, G. Kleinpeter, J. Kish, Daniel K. Resnick, J. Lang, Dhanesh K. Gupta, E. Knosp, N. Monteiro de Oliveira, D. Moskopp, Carin A. Hagberg, J. Howell, Klaus Hahnenkamp, Gregory M. Davis, T. Phan, Paul S. Myles, C. Beven, F. Salevsky, Maria Matuszczak, E. Mee, David L. Bogdonoff, P. Berklayd, J. Freyhoff, P. Tanzi, A. Law, Barbara A. Dodson, Z. Thayer, R. Govindaraj, Alex Konstantatos, Ralph F. Frankowski, Pirjo H. Manninen, David G. Piepgras, K. Willmann, E. Babayan, Donald S. Prough, Leslie C. Jameson, John A. Wilson, Mary Pat McAndrews, M. Abou-Madi, Steven S. Glazier, Vincent C. Traynelis, Derek A. Taggard, Fredric B. Meyer, C. Bradfield, Hoang P. Nguyen, Mary L. Marcellus, J. Ogden, M. Maleki, M. Lotto, Michael A. Olympio, C. Merhaut, D. Nye, K. Webb, Richard Leblanc, Nichol McBee, William L. Lanier, A. Molnar, Peter J. Lennarson, S. Wadanamby, H. Hulbert, Christopher R. Turner, H. Fraley, Kevin K. Tremper, Sesto Cairo, J. Shafer, J. Krugh, D. Blair, L. Coghlan, P. Schmid, K. O'Brien, K. Littlewood, T. Anderson, R. Eliazo, S. Wirtz, Carol B. Applebury, Jennifer O. Hunt, S. Hickenbottom, Hendrik Freise, Gary D. Steinberg, M. Woodfield, Robert J. Dempsey, Kirk J. Hogan, M. Harrison, H. Stanko, Teresa Bell-Stephens, N. Merah, T. Blount, J. Sanders, J. Biddulph, Tsutomu Sasaki, F. Mensink, P. Balestrieri, Lisa D. Ravdin, H. Lohmann, M. Todd, James Gebel, Lawrence Litt, Christoph Schul, B. White, Bradley J. Hindman, S. Salerno, A. James, D. Manke, Mvon Lewinski, D. Luu, Michael M. Todd, A. Drnda, S. Salsbury, J. Palmisano, L. Connery, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, R. Sawyer, A. Sills, D. Sinclair, J. Bramhall, Ira J. Rampil, David M. Colonna, M. Geraghty, Steven W. Anderson, V. Petty, S. Pai, J. Sheehan, S. Black, K. English, N. Scurrah, Diana G. McGregor, P. Davies, P. Doyle-Pettypiece, H. Bone, Neal J. Naff, M. Lenaerts, James Mitchell, K. Pedersen, Matthew A. Howard, M. Angliss, Daniel Tranel, Bongin Yoo, M. Irons, Emine O. Bayman, C. Skilbeck, Nicholas G. Bircher, Wendy C. Ziai, S. Micallef, Chuanyao Tong, Kathryn Chaloner, Mark T. Wallace, John Moloney, Gavin Fabinyi, P. Sutton, Edward C. Nemergut, Elizabeth Richardson, C. McCleary, M. Graf, Mrinalini Balki, P. Porter, James J. Evans, A. Prabhu, L. Kim, R. Hendrickson, A. Dashfield, V. Portman, Michel T. Torbey, J. Kruger, Donna L. Auer, J. Sorenson, Patricia H. Davis, John A. Walker, M. Mosier, H. Smith, J. Heidler, Andrew Silvers, P. Fogarty-Mack, William F. Chandler, F. Shutway, F. Rasulo, S. Alatakis, Stephen Samples, A. Wray, Henry H. Woo, John A. Ulatowski, Steven L. Giannotta, D. Chandrasekara, J. Sturm, S. Crump, Peter A. Rasmussen, Max R. Trenerry, D. Novy, Wink S. Fisher, N. Quinnine, F. Bardenhagen, M. Angle, W. Ng, G. Ferguson, A. Blackwell, Christopher M. Loftus, James H. Fitzpatrick, David S. Warner, E. Tuerkkan, W. Kutalek, Ferenc E. Gyulai, D. Daly, Helen Fletcher, J. Smith, Mazen A. Maktabi, Howard Yonas, J. Sneyd, M. Menhusen, Johnny E. Brian, K. Smith, R. Watson, T. Weber, D. Greene-Chandos, M. Wichman, Peter Szmuk, J. Birrell, Pekka Talke, J. Jane, L. Atkins, J. Smart, T. Han, B. O'Brien, R. Mattison, Bermans J. Iskandar, J. Ridgley, S. Dalrymple, L. Lindsey, D. Anderson, Julie B. Weeks, M. Felmlee-Devine, P. Deshmukh, D. Ellegala, L. Moss, A. Mathur, F. Lee, F. Sasse, H. Macgregor, R. Peterson, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, L. Carriere, Mark Wilson, R. Morgan, T. Costello, C. Thien, Arthur M. Lam, H. Bybee, C. Salmond, Robert E. Breeze, Peter Karzmark, Monica S. Vavilala, S. Yantha, Philip E. Stieg, Guy L. Clifton, Kenneth Manzel, D. Papworth, Rafael J. Tamargo, Rosemary A. Craen, Harold P. Adams, B. Radziszewska, Y. Kuo, Satwant K. Samra, B. Frankel, R. Fry, T. Cunningham, M. Mosa, M. McTaggart, F. Steinman, Alex Abou-Chebl, Michael J. Link, Rona G. Giffard, N. Lapointe, C. Meade, Robert F. Bedford, J. Cormack, Robert P. From, J. Reynolds, Paul A. Leonard, K. Quader, N. Subhas, C. Lothaller, S. Ryan, J. Winn, H. Brors, Amin B. Kassam, A. Gelb, J. Zaroff, Gregory M. Malham, A. Redmond, Gordon J. Chelune, J. Findlay, Zeyd Ebrahim, L. Forlano, Mark E. Shaffrey, C. Chase, Peter J. Kirkpatrick, Armin Schubert, L. Koller, Jana E. Jones, P. Li, and B. Chen

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Interventional cardiology, business.industry, Vascular disease, Perioperative, Hypothermia, medicine.disease, Preoperative care, Anesthesiology and Pain Medicine, Aneurysm, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business
Abstract

Background Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. Methods The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. Results There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). Conclusion In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.

Published
2010
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2. No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

Author

John A. Ulatowski, Steven L. Giannotta, J. Sturm, D. Cowie, D. Novy, N. Quinnine, James H. Fitzpatrick, David S. Warner, Ferenc E. Gyulai, D. Daly, S. Rice, H. Machlin, William T. Clarke, Philip E. Bickler, H. Van Aken, M. Langley, M. von Lewinski, G. Kleinpeter, J. Freyhoff, A. Morris, L. Salvia, Peter M. C. Wright, Wolfgang K. Pfisterer, K. English, M. Lenaerts, Nicholas G. Bircher, Simon Jones, L. Jensen, Issam A. Awad, P. Chery, B. Schaefer, S. Wallace, F. Johnson, H. Smith, J. Biddulph, T. Cunningham, N. Monteirode Oliveira, R. Watson, A. McAllister, D. Moskopp, Patricia H. Petrozza, B. Hindman, A. Shelton, D. Manke, F. Steinman, D. Luu, Alex Abou-Chebl, J. Birrell, M. Irons, J. Ridgley, Gavin Fabinyi, S. Alatakis, Basil F. Matta, James J. Evans, A. Prabhu, Rona G. Giffard, H. Gramke, Hendrik Freise, K. Graves, P. Fogarty-Mack, L. Clark, Wink S. Fisher, K. Smith, Renee Testa, P. D'Urso, A. Freymuth, James C. Torner, M. Wallace, R. Struthers, Howard A. Riina, Z. Thayer, Daniel Tranel, E. Knosp, E. Dy, Tord D. Alden, Henry H. Woo, Bruce P. Hermann, John C. VanGilder, Douglas Campbell, N. Lapointe, Gavin W. Britz, J. Sheehan, C. Meade, M. Balki, C. Bradfield, Alessandro Olivi, P. Doyle-Pettypiece, Robert F. Bedford, F. Bardenhagen, M. Angle, Donald S. Prough, John E. McGillicuddy, A. Drnda, M. Abou-Madi, S. Black, David R. McIlroy, Lis Evered, S. Poustie, J. Cormack, J. Sneyd, M. Menhusen, William L. Lanier, M. Maleki, T. Phan, D. Nye, M. Graf, Michael A. Olympio, N. Robertson, Teresa Bell-Stephens, E. Tuerkkan, N. Merah, S. Olson, L. Kirby, L. Moss, Peter Heppner, Thomas A. Moore, J. Bramhall, H. Madder, Christopher R. Turner, H. Fraley, James Mitchell, K. Pedersen, M. Angliss, Robert P. From, Y. Painchaud, Gary D. Steinberg, J. Woelfer, K. Littlewood, T. Anderson, J. Palmisano, M. Clausen, Paul H. Ting, Lisa D. Ravdin, H. Lohmann, R. Burnstein, R. Popovic, T. Hartman, D. Anderson, Julie B. Weeks, H. Macgregor, Kirk J. Hogan, D. Chatfield, Daniel H. Kim, James R. Munis, J. Lang, J. Reynolds, Michael M. Todd, F. Mensink, L. Pobereskin, J. Walkes, Mary Pat McAndrews, A. Sills, Bongin Yoo, P. Balestrieri, S. Micallef, Mary L. Marcellus, J. Wang, Kathryn Chaloner, Patrick W. Hitchon, Paul A. Leonard, C. McCleary, Lawrence Litt, N. Subhas, Wendy C. Ziai, James H McMahon, V. Petty, P. Smythe, G. Heard, Michael J. Souter, R. Hendrickson, A. Dashfield, V. Portman, Edward C. Nemergut, Patricia H. Davis, W. Burnett, M. Lotto, Y. Young, S. Jackson, J. Quaedackers, S. Ryan, Helen Fletcher, A. Ashtari, N. F. Kassell, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, J. Winn, Bradley J. Hindman, S. Salerno, L. Kim, R. Sawyer, Peter J. Lennarson, S. Wadanamby, Zhiyi Zuo, William F. Chandler, F. Shutway, P. Bennett, C. Merhaut, D. Hill, J. Haartsen, N. Badner, T. Weber, Rafael J. Tamargo, D. Fishback, Rosemary A. Craen, Michel T. Torbey, O. Odukoya, D. Chartrand, J. Jane, Michael T. Lawton, A. Buchmann, Richard A. Jaffe, P. Berklayd, T. Blount, J. Sanders, J. Marler, L. Meng, R. Grauer, Y. Kuo, O. Moise, P. Tanzi, R. Govindaraj, Alex Konstantatos, D. Greene-Chandos, G. Downey, M. Wichman, D. Chandrasekara, Amin B. Kassam, Max R. Trenerry, R. Elbe, A. Wyss, R. Peterson, D. Sirhan, C. Miller, Marek A. Mirski, Stephen Samples, H. Brors, Michael Beven, M. Woodfield, William L. Young, D. Leggett, A. Wray, Karen B. Domino, Robert Greif, Argye E. Hillis, Gary G. Ferguson, Steven S. Glazier, J. Shafer, J. Krugh, I. Gibmeier, G. Ghazali, W. Ng, R. Tack, R. Schatzer, B. O'Brien, Bermans J. Iskandar, B. Bauer, C. Lind, C. Weasler, Michael Tymianski, E. Tuffiash, W. Hamm, C. Hall, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, Richard Leblanc, A. Shahen, Laurel E. Moore, S. Bhatia, Nichol McBee, P. Davies, James Gebel, Cynthia A. Lien, J. Ormrod, David M. Colonna, D. Dehring, A. Rushton, P. Blanton, C. Lothaller, Diana G. McGregor, S. Harding, Lauren C. Berkow, D. Van Alstine, M. Hemstreet, A. Blackwell, Christopher M. Loftus, Klaus Hahnenkamp, J. Woletz, D. Lindholm, K. Kieburtz, M. Geraghty, Steven W. Anderson, D. Dulli, M. McTaggart, Fred Gentili, Johnny E. Brian, R. Peters, C. Greiner, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, B. Radziszewska, Maria Matuszczak, David L. Bogdonoff, K. Quader, Pekka Talke, B. Hodkinson, C. Hoenemann, C. Duffy, Deborah A. Rusy, R. Silbergleit, J. Findlay, Gregory M. Davis, J. Ogden, Adrian W. Gelb, A. Kane, Satwant K. Samra, E. Babayan, S. Dalrymple, Harry J. M. Lemmens, Tsutomu Sasaki, Lisa Hannegan, R. Eliazo, B. Frankel, D. Bisnaire, F. Salevsky, Michael J. Link, Jeffrey V. Rosenfeld, D. Sage, D. Sinclair, Keith H. Berge, D. Wilhite, Steven D. Chang, J. Kish, Carin A. Hagberg, Matthew A. Howard, Elizabeth Richardson, Peter C. Whitfield, D. Bain, Barbara A. Dodson, S. Crump, David G. Piepgras, John A. Wilson, David W. Newell, R. Deam, John Laidlaw, K. Willmann, J. Heidler, Vincent C. Traynelis, K. Webb, P. Li, A. Mathur, S. Hickenbottom, S. Wirtz, L. Lindsey, H. Stanko, Mark Wilson, S. Salsbury, L. Connery, Robert J. Dempsey, Edward W. Mee, R. Morgan, Ira J. Rampil, V. Roelfsema, Christoph Schul, B. White, A. James, N. Scurrah, C. Thien, Arthur M. Lam, P. Mak, Behnam Badie, Guy L. Clifton, R. Wilson, J. Kruger, Donna L. Auer, M. Mosier, S. Nobles, David J. Stone, A. Law, Timothy G. Short, W. Lilley, H. Yi, Marcel E. Durieux, Daniel K. Resnick, Dhanesh K. Gupta, Paul S. Myles, C. Beven, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, Leslie C. Jameson, G. Seever, Stephen P. Lownie, Fredric B. Meyer, P. Porter, K. O'Brien, Vladimir Zelman, John L.D. Atkinson, A. Molnar, H. Hulbert, S. Pai, Neal J. Naff, S. Shaikh, M. Mosa, Pirjo H. Manninen, Derek A. Taggard, Ian A. Herrick, Mark E. Shaffrey, Carol B. Applebury, C. Chase, Neil Duggal, Mark Buckland, M. Quigley, D. Milovan, Michael J. Harrison, Peter J. Kirkpatrick, Armin Schubert, R. Mattison, Ralph F. Frankowski, R. Chelliah, Jana E. Jones, J. Howell, H. Bone, Emine O. Bayman, P. Deshmukh, C. Skilbeck, P. Sutton, B. Chen, L. Carriere, J. Sorenson, Andrew Silvers, F. Sasse, F. Rasulo, Gordon J. Chelune, Zeyd Ebrahim, L. Forlano, Chuanyao Tong, John Moloney, Michael P. Murphy, S. Yantha, W. Kutalek, Kevin K. Tremper, C. Chambers, Sesto Cairo, Robert E. Breeze, A. Meyer, Monica S. Vavilala, C. Salem, H. El-Beheiry, Gregory M. Malham, A. Redmond, L. Koller, Kenneth Manzel, D. Papworth, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, D. Ellegala, Kevin H. Siu, Lorri A. Lee, Phillip A. Scott, K. Lukitto, Jennifer O. Hunt, D. Blair, P. Schmid, M. Felmlee-Devine, Peter A. Rasmussen, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, and John A. Walker

Subjects
medicine.medical_specialty, business.industry, Vascular disease, Glasgow Outcome Scale, Odds ratio, Hypothermia, medicine.disease, law.invention, Surgery, Anesthesiology and Pain Medicine, Aneurysm, Randomized controlled trial, law, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business, Prospective cohort study
Abstract

Background Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. Conclusion In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Published
2010
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3. Effect of Single-Dose Dexamethasone on Blood Glucose Concentration in Patients Undergoing Craniotomy

Author

Jeffrey J. Pasternak, William L. Lanier, and Diana G. McGregor

Subjects
Blood Glucose, Male, medicine.drug_class, medicine.medical_treatment, Anti-Inflammatory Agents, Ischemia, Brain Edema, Placebo, Dexamethasone, Neurosurgical Procedures, Cerebral edema, Monitoring, Intraoperative, medicine, Humans, Anesthesia, Saline, Aged, business.industry, Venous blood, Middle Aged, medicine.disease, Anesthesiology and Pain Medicine, Corticosteroid, Arterial blood, Female, Surgery, Neurology (clinical), business, Craniotomy, medicine.drug
Abstract

Dexamethasone, a corticosteroid used to treat cerebral edema, is known to produce elevations in the blood glucose concentration, but the effect of a single intraoperative dose of dexamethasone on the blood glucose concentration is unknown. Glucose concentrations in response to either a 10-mg intravenous bolus of dexamethasone or a saline placebo were evaluated in nondiabetic patients undergoing elective craniotomy. Both arterial and venous blood glucose concentrations were obtained immediately before and after treatment and hourly for 4 hours intraoperatively. The arterial blood glucose concentration in those who received 10 mg dexamethasone (n = 10) increased from 97 +/-15 mg/dL (mean +/- SD) to 149 +/- 23 mg/dL over the course of the study, compared with a change from 88 +/- 11 mg/dL to 103+/-12 mg/dL in those who received placebo (n = 10) (P < 0.05 for 4-hour sample vs. baseline for both groups; P < 0.05 between groups at 4 hours). Further, venous blood glucose concentrations were highly predictive of arterial glucose values (R = 0.98; P < 0.001). Since elevations in the blood glucose concentration should be avoided in the setting of central nervous system ischemia, findings from this investigation suggest that contemplated corticosteroid use should be reviewed for appropriateness of treatment. If dexamethasone is used, even as a single dose during craniotomy, intraoperative blood glucose concentrations should be carefully monitored and hyperglycemia treated, particularly in patients at risk for glucose-mediated exacerbation of brain injury.

Published
2004
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4. Contributors

Author

Michael A. Acquaviva, Brenton Alexander, Steven J. Barker, Richard Beers, James M. Berry, Gerardo Bosco, Sorin J. Brull, Enrico Camporesi, Maxime Cannesson, Jeffrey B. Cooper, Stephen F. Dierdorf, Jan Ehrenwerth, John H. Eichhorn, James B. Eisenkraft, Roger Eltringham, Chris R. Giordano, Nikolaus Gravenstein, Simon C. Hillier, Robert S. Holzman, Nicole Horn, Michael B. Jaffe, Ken B. Johnson, Wilton C. Levine, Robert G. Loeb, S. Nini Malayaman, Keira P. Mason, Diana G. McGregor, William L. McNiece, Raj K. Modak, George Mychaskiw, Mohamed Naguib, Jolie Narang, Michael A. Olympio, David G. Osborn, Bijal R. Parikh, James H. Philip, Timothy J. Quill, Henry Rosenberg, William H. Rosenblatt, Brian S. Rothman, Keith J. Ruskin, Harry A. Seifert, Maire Shelly, George Sheplock, David G. Silverman, Theodore Craig Smith, Craig Spencer, Collin Sprenker, Paul St. Jacques, Tracey Straker, John T. Sullivan, Elizabeth M. Thackeray, Daniel M. Thys, Steven G. Venticinque, Kyle A. Vernest, Scott G. Walker, Matthew B. Weinger, and Ross H. Zoll

Published
2013
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6. Preoperative Antiplatelet Therapy Does Not Increase the Risk of Spinal Hematoma Associated with Regional Anesthesia

Author

Denise J. Wedel, Gilbert Y. Wong, Steven H. Rose, Darrell R. Schroeder, Beth A. Elliott, Terese T. Horlocker, and Diana G. McGregor

Subjects
Adult, Anesthesia, Epidural, Male, medicine.medical_specialty, Antiplatelet drug, Adolescent, medicine.medical_treatment, Anesthesia, Spinal, Spinal Puncture, Hematoma, medicine, Humans, Spinal canal, Prospective Studies, Risk factor, Aged, Aged, 80 and over, Aspirin, business.industry, Platelet Count, Middle Aged, medicine.disease, Epidural space, Surgery, Catheter, medicine.anatomical_structure, Orthopedics, Anesthesiology and Pain Medicine, Anesthesia, Female, Spinal Diseases, business, Complication, Platelet Aggregation Inhibitors, medicine.drug
Abstract

One thousand orthopedic procedures in 924 patients given spinal or epidural anesthesia were prospectively studied to determine the risk of hemorrhagic complications associated with regional anesthesia. A history of excessive bruising or bleeding was elicited in 115 (12%) patients. Preoperative antiplatelet medications were taken by 386 (39%) patients. Aspirin was the most frequently reported antiplatelet drug and was taken by 193 patients. Subcutaneous heparin was administered to 22 patients before surgery on the operative day. One patient of 774 tested had a preoperative platelet count less than 100,000/mm3. In addition, 26 of 171 preoperative prothrombin times and 10 of 115 preoperative activated partial thromboplastin times were longer than normal. Only 31 preoperative bleeding times were performed; five were prolonged. There were no documented spinal hematomas (major hemorrhagic complications). Blood was noted during needle or catheter placement (minor hemorrhagic complication) in 223 (22%) patients, including 73 patients with frank blood in the needle or catheter. Preoperative antiplatelet therapy did not increase the incidence of minor hemorrhagic complications. However, female gender, increased age, a history of excessive bruising/bleeding, surgery to the hip, continuous catheter anesthetic technique, large needle gauge, multiple needle passes, and moderate or difficult needle placement were all significant risk factors. The lack of correlation between antiplatelet medications and bloody needle or catheter placement (producing clinically insignificant collections of blood in the spinal canal or epidural space) is strong evidence that preoperative antiplatelet therapy is not a significant risk factor for the development of neurologic dysfunction from spinal hematoma in patients who undergo spinal or epidural anesthesia while receiving these medications.

Published
1995
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7. Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage

Author

David G. Piepgras, David R. McIlroy, John A. Wilson, H. Yi, Lis Evered, J. Sheehan, Marcel E. Durieux, Daniel K. Resnick, L. Kirby, M. Abou-Madi, Michael A. Olympio, Dhanesh K. Gupta, Peter Heppner, Thomas A. Moore, Paul S. Myles, S. Wirtz, Richard Leblanc, C. Beven, Robert J. Dempsey, Edward W. Mee, Nichol McBee, P. Davies, V. Roelfsema, Christoph Schul, B. White, Leslie C. Jameson, A. James, R. Popovic, Kirk J. Hogan, Fredric B. Meyer, Klaus Hahnenkamp, Patrick W. Hitchon, L. Clark, M. Geraghty, Qian Shi, R. Struthers, Howard A. Riina, A. Drnda, D. Chartrand, Bradley J. Hindman, S. Salerno, E. Knosp, J. Bramhall, Bruce P. Hermann, A. Ashtari, N. F. Kassell, Steven W. Anderson, Maria Matuszczak, David L. Bogdonoff, B. Schaefer, John C. VanGilder, K. O'Brien, A. McAllister, D. Luu, L. Jensen, Issam A. Awad, P. Chery, S. Wallace, H. Smith, N. Monteirode Oliveira, G. Downey, R. Elbe, A. Wyss, E. Babayan, J. Woletz, H. Gramke, M. Irons, Gavin Fabinyi, O. Odukoya, R. Hendrickson, Vincent C. Traynelis, A. Dashfield, V. Portman, Alessandro Olivi, James J. Evans, A. Prabhu, Peter C. Whitfield, Gary D. Steinberg, S. Rice, H. Machlin, D. Bisnaire, P. Berklayd, G. Kleinpeter, Patricia H. Davis, D. Bain, William F. Chandler, R. Wilson, W. Ng, K. Webb, F. Shutway, D. Manke, W. Pfisterer, K. Smith, M. Mosa, Michael M. Todd, R. Tack, Philip E. Bickler, S. Alatakis, A. Shahen, D. Dehring, David W. Newell, A. Sills, K. Lukitto, Wink S. Fisher, R. Watson, Teresa Bell-Stephens, Donald S. Prough, M. Maleki, D. Nye, M. Graf, S. Nobles, David J. Stone, Hendrik Freise, R. Deam, John Laidlaw, K. Quader, Douglas Campbell, Fred Gentili, S. Hickenbottom, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, Gavin W. Britz, M. Langley, Mary Pat McAndrews, Wendy C. Ziai, Behnam Badie, C. Duffy, Deborah A. Rusy, K. Littlewood, T. Anderson, J. Palmisano, H. Stanko, Henry H. Woo, Edward C. Nemergut, C. Bradfield, A. Molnar, John A. Walker, Christina M. Spofford, D. Dulli, A. Kane, J. Birrell, Harry J. M. Lemmens, M. Lotto, Y. Young, J. Biddulph, T. Cunningham, L. Kim, K. Graves, B. Radziszewska, S. Salsbury, Lawrence Litt, S. Black, F. Bardenhagen, M. Angle, L. Connery, Lisa Hannegan, Helen Fletcher, John A. Ulatowski, Steven L. Giannotta, J. Sturm, R. Sawyer, H. Hulbert, A. Morris, James Mitchell, M. von Lewinski, C. Merhaut, L. Salvia, A. Freymuth, James C. Torner, D. Cowie, Bongin Yoo, Y. Kuo, S. Micallef, Kathryn Chaloner, Neil Duggal, J. Ogden, Peter M. C. Wright, K. Pedersen, C. McCleary, P. Mak, Paul H. Ting, S. Shaikh, B. Hodkinson, J. Sneyd, D. Novy, M. Menhusen, N. Quinnine, James H. Fitzpatrick, Timothy G. Short, M. Angliss, R. Burnstein, D. Moskopp, N. Robertson, Mark Buckland, Jeffrey V. Rosenfeld, W. Lilley, T. Phan, D. Greene-Chandos, M. Wichman, David S. Warner, M. Quigley, P. Tanzi, Ferenc E. Gyulai, D. Daly, Satwant K. Samra, B. Frankel, D. Wilhite, L. Lindsey, K. English, M. Lenaerts, Michel T. Torbey, T. Hartman, John E. McGillicuddy, R. Govindaraj, Alex Konstantatos, M. Woodfield, Steven S. Glazier, Steven D. Chang, C. Greiner, F. Steinman, Alex Abou-Chebl, G. Heard, S. Yantha, Michael J. Souter, C. Hoenemann, Nicholas G. Bircher, H. Van Aken, S. Poustie, D. Hill, J. Kish, Carin A. Hagberg, A. Buchmann, B. O'Brien, J. Shafer, J. Krugh, D. Chandrasekara, R. Eliazo, Mary L. Marcellus, Anish Bhardwaj, E. Thomson, H. El-Beheiry, Bermans J. Iskandar, J. Ormrod, D. Milovan, Michael J. Link, Barbara A. Dodson, S. Crump, K. Willmann, H. Madder, William R. Clarke, Max R. Trenerry, Ramez W. Kirollos, James Gebel, Lisa D. Ravdin, D. Sirhan, C. Miller, R. Grauer, Ira J. Rampil, W. Burnett, Marek A. Mirski, D. Chatfield, J. Haartsen, Jing Wang, H. Lohmann, T. Weber, S. Jackson, J. Quaedackers, Michael Beven, N. Scurrah, L. Pobereskin, J. Walkes, Zhiyi Zuo, Rona G. Giffard, J. Ridgley, James H McMahon, P. Bennett, J. Freyhoff, J. Reynolds, R. Chelliah, J. Jane, Basil F. Matta, P. Smythe, I. Gibmeier, A. Mathur, Karen B. Domino, Robert Greif, A. Wray, W. Hamm, C. Hall, Ralph F. Frankowski, H. Brors, Renee Testa, D. Fishback, Laurel E. Moore, Richard A. Jaffe, O. Moise, P. D'Urso, Argye E. Hillis, C. Weasler, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, David M. Colonna, C. Lothaller, S. Bhatia, H. Bone, S. Harding, Diana G. McGregor, Lauren C. Berkow, A. Gelb, Paul A. Leonard, N. Subhas, Emine O. Bayman, William L. Young, A. Rushton, J. Marler, J. Kruger, Donna L. Auer, D. Lindholm, K. Kieburtz, R. Schatzer, D. Leggett, M. Mosier, D. Anderson, Julie B. Weeks, B. Bauer, F. Saleversusky, Mark Wilson, C. Skilbeck, R. Morgan, D. Van Alstine, S. Olson, M. Hemstreet, Y. Painchaud, P. Sutton, A. Blackwell, Christopher M. Loftus, S. Ryan, J. Winn, R. Silbergleit, R. Peters, J. Woelfer, M. Clausen, Daniel H. Kim, James R. Munis, J. Lang, A. Law, N. Badner, Keith H. Berge, D. Ellegala, Kevin H. Siu, Gordon J. Chelune, Rafael J. Tamargo, Rosemary A. Craen, C. Thien, Peter J. Lennarson, S. Wadanamby, R. Peterson, T. Blount, J. Sanders, Amin B. Kassam, Arthur M. Lam, Z. Thayer, N. Lapointe, C. Meade, Robert F. Bedford, Lorri A. Lee, J. Cormack, E. Tuerkkan, L. Carriere, N. Merah, Robert P. From, J. Sorenson, Phillip A. Scott, S. Pai, Neal J. Naff, Andrew Silvers, P. Fogarty-Mack, Jennifer O. Hunt, P. Porter, Guy L. Clifton, Zeyd Ebrahim, F. Rasulo, Pirjo H. Manninen, Derek A. Taggard, Michael J. Harrison, Ian A. Herrick, R. Mattison, Tsutomu Sasaki, P. Deshmukh, L. Forlano, Vladimir Zelman, Carol B. Applebury, John L.D. Atkinson, D. Sage, D. Sinclair, Matthew A. Howard, Elizabeth Richardson, F. Sasse, J. Heidler, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, G. Seever, Stephen P. Lownie, M. Wallace, Mark E. Shaffrey, C. Chase, Robert E. Breeze, Monica S. Vavilala, Kenneth Manzel, D. Papworth, Peter J. Kirkpatrick, Jana E. Jones, J. Howell, P. Li, B. Chen, A. Meyer, C. Salem, W. Kutalek, L. Koller, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, Gregory M. Malham, A. Redmond, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, Michael P. Murphy, Kevin K. Tremper, C. Chambers, Sesto Cairo, Chuanyao Tong, John Moloney, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, D. Blair, P. Schmid, Peter A. Rasmussen, Stephen Samples, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, M. Balki, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, C. Lind, M. McTaggart, Johnny E. Brian, Pekka Talke, S. Dalrymple, M. Felmlee-Devine, Simon Jones, G. Ghazali, F. Johnson, Patricia H. Petrozza, B. Hindman, A. Shelton, Daniel Tranel, P. Blanton, L. Moss, H. Macgregor, J. Findlay, J. Weeks, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, Gregory M. Davis, William L. Lanier, Christopher R. Turner, H. Fraley, F. Mensink, P. Balestrieri, V. Petty, Michael T. Lawton, L. Meng, Gary G. Ferguson, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, E. Dy, Tord D. Alden, and P. Doyle-Pettypiece

Subjects
Perioperative fever, Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Neuropsychological Tests, Severity of Illness Index, Neurosurgical Procedures, Statistics, Nonparametric, Hypothermia, Induced, Severity of illness, Medicine, Humans, Aged, Retrospective Studies, Neurologic Examination, Intraoperative Care, business.industry, Glasgow Outcome Scale, Incidence, Retrospective cohort study, Perioperative, Middle Aged, Subarachnoid Hemorrhage, outcome, aneurysmal subarachnoid hemorrhage, medicine.disease, Hydrocephalus, Surgery, Clinical trial, Logistic Models, Anesthesia, Female, Neurology (clinical), Intraoperative Period, business
Abstract

OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.

Published
2009

8. Hyperglycemia in patients undergoing cerebral aneurysm surgery: its association with long-term gross neurologic and neuropsychological function

Author

Jeffrey J. Pasternak, Qian Shi, William L. Lanier, Darrell R. Schroeder, Julie B. Weeks, Diana G. McGregor, Bradley J. Hindman, William R. Clarke, Michael M. Todd, and James C. Torner

Subjects
Blood Glucose, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Time Factors, Logistic regression, Brain Ischemia, Central nervous system disease, Aneurysm, Cognition, Postoperative Complications, Risk Factors, Monitoring, Intraoperative, medicine, Humans, In patient, Retrospective Studies, Vascular disease, business.industry, Intracranial Aneurysm, General Medicine, Length of Stay, Middle Aged, medicine.disease, Prognosis, Hypoglycemia, Surgery, Quartile, Anesthesia, Aneurysm surgery, Female, business, Vascular Surgical Procedures, Follow-Up Studies
Abstract

To evaluate whether elevated intraoperative blood glucose concentrations are associated with an increased risk of long-term neurologic dysfunction in patients at risk for ischemic brain injury.Data from 1000 patients were retrieved from the Intraoperative Hypothermia for Aneurysm Surgery Trial database. All patients were recruited between February 2000 and April 2003, and underwent surgery for aneurysm clipping within 14 days of subarachnoid hemorrhage. Gross neurologic and neuropsychological function was evaluated at 3 months after surgery using certified observers and standardized assessment instruments. Intraoperative blood glucose concentrations, measured once when the aneurysm clip was placed, were correlated with neurologic outcome using both univariable and multivariable logistic regression analyses.Blood glucose concentrations at the time of aneurysm clipping ranged from 59 to 331 mg/dL. At 3 months after surgery, those with blood glucose concentrations of 129 mg/dL or more (upper 2 quartiles) were more likely to have impaired cognition (P=.03). Those with glucose concentrations of 152 mg/dL or more (upper quartile) were more likely to experience deficits in gross neurologic function assessed by the National Institutes of Health Stroke Scale (P.05), but not other scoring scales. Length of stay in intensive care units was longer in those with glucose concentrations of 129 mg/dL or more, but there was no difference among glucose groups in the duration of overall hospital stay or the fraction of patients discharged to home.In patients at high risk for ischemic brain injury, intraoperative hyperglycemia, of a magnitude commonly encountered clinically, was associated with long-term changes in cognition and gross neurologic function.

Published
2008

9. Trace nitrous oxide levels in the postanesthesia care unit

Author

Diana G. McGregor, Richard I. Mazze, and David H. Senjem

Subjects
Postanesthesia care, biology, business.industry, Nitrous Oxide, Nitrous oxide, Air Pollutants, Occupational, biology.organism_classification, Occupational safety and health, Ambient air, Pacu, chemistry.chemical_compound, Anesthesiology and Pain Medicine, chemistry, Anesthesia, Anesthetic, Anesthesia Recovery Period, Anesthetics, Inhalation, medicine, Humans, business, Postanesthesia Nursing, Hospital Units, medicine.drug
Abstract

UNLABELLED The effect of trace levels of waste anesthetic gases on the health of postanesthesia care unit (PACU) nurses who work in an unscavenged environment has been questioned, although it seems likely that levels of trace gases in the PACU would be much lower than those in the operating room. In this study, we documented nitrous oxide levels in the ambient air of two large PACUs. Nitrous oxide levels were measured using a time-weighted average monitor worn by 33 PACU workers at two different hospitals for the duration of their shifts. On the same day, patient data were collected at the time of admission to the PACU. Data included age and weight of the patient, type of surgery, anesthetic technique, and end-tidal level of nitrous oxide immediately before the patient left the operating room. The mean time-weighted average nitrous oxide level in PACU A was 2.0 ppm (range 0-6.4); in PACU B, it was undetectable, i.e., < 2.0 ppm. Levels of nitrous oxide to which PACU patient care personnel are exposed are well below the National Institute of Occupational Safety and Health and Occupational Health and Safety Administration recommended exposure level of 25 ppm measured for the duration of anesthetic administration. IMPLICATIONS Our results indicate that the levels of nitrous oxide in postanesthesia care units with well maintained, modern ventilation systems are very low. Previous research suggests that the health of workers exposed to these levels should not be adversely affected.

Published
1999

10. Effect of Nitrous Oxide on Neurologic Function Following Intracranial Aneurysm Surgery

Author

Deborah A. Rusy, Michael M. Todd, Jeffrey J. Pasternak, Diana G. McGregor, Hogan K, Satwant K. Samra, Bradley J. Hindman, Darrell R. Schroeder, James C. Torner, William R. Clarke, and William L. Lanier

Subjects
medicine.medical_specialty, business.industry, Nitrous oxide, Surgery, chemistry.chemical_compound, Anesthesiology and Pain Medicine, Neurologic function, chemistry, Anesthesia, medicine, Aneurysm surgery, Neurology (clinical), business
Published
2005
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11. Relationship Between Blood Glucose Concentration and Both Postoperative Infections and Neurologic Function in Patients Undergoing Cerebral Aneurysm Clipping

Author

Schroeder Ds, William L. Lanier, Michael M. Todd, Jeffrey J. Pasternak, Bradley J. Hindman, and Diana G. McGregor

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, Neurologic function, Aneurysm clipping, business.industry, Anesthesia, Medicine, Surgery, In patient, Neurology (clinical), business
Published
2005
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12. Neurologic Complications of 603 Consecutive Continuous Spinal Anesthetics Using Macrocatheter and Microcatheter Techniques

Author

Darrell R. Schroeder, Robert C. Chantigian, Diana G. McGregor, Terese T. Horlocker, Jennifer A. Besse, and Derek K. Matsushige

Subjects
Epidural blood patch, medicine.medical_specialty, business.industry, Aseptic meningitis, Cauda equina syndrome, Neurological disorder, medicine.disease, Surgery, Catheter, Anesthesiology and Pain Medicine, Anesthesia, Anesthetic, Orthopedic surgery, medicine, Complication, business, medicine.drug
Abstract

Recent case reports of cauda equina syndrome after continuous spinal anesthesia have led to a reevaluation of the indications and applications of this regional anesthetic technique. However, few large studies have formally investigated the frequency of neurologic complications using macro- and microcatheter (smaller than 24 gauge) techniques. This retrospective review examines 603 continuous spinal anesthetics, including 127 administered through a 28-gauge microcatheter, performed between June 1987 and May 1992. The surgical procedure was orthopedic in 397 of 476 (83.4%) macrocatheter patients. All microcatheter patients were parturients. Three patients reported pain (persistent paresthesia) postoperatively. In two patients, the symptoms resolved in 4 days; the other patient was discharged 8 days postoperatively with residual foot pain. There was also one patient with aseptic meningitis and one patient with a sensory cauda equina syndrome (still present after 15 mo). There were 58 (9.6%) patients with a postdural puncture headache (PDPH), including 42 of 127 (33.1%) patients in the microcatheter group. An epidural blood patch was performed in 41 (6.8%) patients. The frequency of neurologic complications, excluding PDPH, is similar to those in published reviews. However, PDPH in microcatheter patients is more frequent than previously reported.

Published
1998
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13. A Retrospective Review of 4767 Consecutive Spinal Anesthetics

Author

Darrell R. Schroeder, Jennifer A. Besse, Terese T. Horlocker, Derek K. Matsushige, and Diana G. McGregor

Subjects
Epidural blood patch, medicine.medical_specialty, business.industry, Genitourinary system, Central nervous system, Retrospective cohort study, Perioperative, medicine.disease, Surgery, Central nervous system disease, medicine.anatomical_structure, Anesthesiology and Pain Medicine, Anesthesia, Orthopedic surgery, medicine, business, Complication
Abstract

Serious neurologic complications rarely occur after spinal anesthesia. Historically, the reported frequency of persistent sensory or motor deficits has ranged from 0.005% to 0.7%. However, the introduction of small-gauge needles and new local anesthetics and intrathecal adjuvants makes it necessary to reevaluate the frequency of neurologic complications after spinal anesthesia. This study is a retrospective review of 4767 consecutive spinal anesthetics performed between June 1987 and June 1990. Mean patients age was 65 +/- 15 yrs. There were 3560 (74.7%) men and 1207 (25.3%) women. A preexisting neurologic condition was present in 481 (10.1%) cases. The surgical procedures were genitourinary and lower extremity orthopedic in 4348 (91.2%) cases. A paresthesia was elicited during needle placement in 298 (6.3%) cases. Six patients reported pain upon resolution of the spinal anesthetic (persistent paresthesia). Four persistent paresthesias resolved within 1 wk; the remaining two resolved in 18-24 mo. The presence of a paresthesia during needle placement significantly increased the risk of persistent paresthesia (P < 0.001). There, were also two infectious complications. One patient with recent (treated) urosepsis underwent a urologic procedure under spinal anesthesia and subsequently developed a disc space infection. The second patient developed a paraspinal abscess. Both were treated with surgical drainage and antibiotics and remained neurologically intact. There were 62 (1.3%) patients with a postdural puncture headache, including 23 (0.5%) who underwent an epidural blood patch. These results are similar to those of previously published reviews and demonstrate the continued safety of spinal anesthesia.

Published
1997
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