المؤلفون: Errico, Michael, Luoma, Astri M.V.

المصدر: Anaesthesia & Intensive Care Medicine; May2023, Vol. 24 Issue 5, p282-290, 9p

مستخلص: Immediately after neurosurgery, the primary aim is to provide continuity of patient care to detect and prevent neurological deterioration while supporting systemic and neurological homeostasis. Surgical-, anaesthetic-, or disease-related factors may contribute to a slow return or failure to regain a patient's preoperative status. The postoperative management of neurosurgical patients requires thorough planning which begins in the preoperative period, incorporating a multidisciplinary team approach involving the neuroanaesthetic, neurosurgical and neurocritical care teams. In many neurosurgical centres, the period of postoperative observation may be relatively short. However, if complicating factors such as cerebral oedema, intracranial haemorrhage, seizures, or significant comorbid conditions are present, a period of higher dependency care over several days may be anticipated. The mainstays of care in the postoperative neurosurgical patient include safe management of the airway and weaning of ventilatory support, optimum control of systemic circulation, stable fluid and electrolyte homeostasis, maintenance of blood glucose and commencement of early feeding, effective analgesia, and control of nausea and vomiting. Meticulous attention to each of these is essential as poor management can profoundly affect neurological outcome. The early postoperative neurosurgical patient therefore continues to require a high degree of clinical vigilance. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Wan A, Wan Zakaria, Luoma, Astri M.V.

المصدر: Anaesthesia & Intensive Care Medicine; Jul2020, Vol. 21 Issue 7, p349-355, 7p

مستخلص: The primary aim immediately after neurosurgery is to provide continuity of patient care to detect and prevent neurological deterioration while supporting systemic and neurological homeostasis. Surgical-, anaesthetic-, or disease-related factors may contribute to a slow return or failure to regain a patient's preoperative status. The postoperative management of neurosurgical patients requires thorough planning which begins in the preoperative period, incorporating a multi-disciplinary team approach involving the neurosurgical and neurocritical care teams. In many neurosurgical centres, the period of postoperative observation may be relatively short. However, if complicating factors such as cerebral oedema, intracranial haemorrhage, seizures, or significant comorbid conditions are present, a period of higher dependency care over several days may be anticipated. The mainstays of care in the postoperative neurosurgical patient include safe management of the airway and weaning of ventilatory support, optimum control of systemic circulation, stable fluid and electrolyte homeostasis, maintenance of blood glucose and commencement of early feeding, effective analgesia, and control of nausea and vomiting. Meticulous attention to each of these is essential as poor management can profoundly affect neurological outcome. The early postoperative neurosurgical patient therefore continues to require a high degree of clinical vigilance. Neurosurgery encompasses several sub-specialties and this article will focus on the postoperative care of patients undergoing intracranial and neuroradiological procedures under local anaesthesia (awake), monitored sedation, and general anaesthesia. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Bose, Gahan, Luoma, Astri M.V.

المصدر: Anaesthesia & Intensive Care Medicine; Jun2017, Vol. 18 Issue 6, p296-303, 8p

مستخلص: The primary aim of care immediately after neurosurgery is to detect and prevent neurological deterioration while supporting systemic and neurological homoeostasis. Surgical-, anaesthetic- or disease- related factors may contribute to a slow return or failure to regain a patient's preoperative status. A period of specific monitoring and observation by nursing and medical staff accustomed to neurosurgical and neurocritical care procedures should be planned for the immediate postoperative period. In many neurosurgical centres the period of postoperative observation may be relatively short (e.g. limited uneventful craniotomies); however, if complicating factors such as cerebral oedema, intracranial haemorrhage, seizures or significant premorbid conditions are present, a period of higher dependency care over several days may be anticipated. In common with all postoperative care safe management of the airway, weaning of ventilatory support, control of circulation and fluid balance, feeding, sedation and analgesia are the mainstays of care. Meticulous attention to each of these is essential in the post neurosurgical patient as poor management can profoundly affect neurological outcome. Thus a robust perioperative plan is mandatory for management of the airway, control of blood pressure, and to ensure continuation of preoperative medication. Furthermore, the plan may entail elective creation of tracheostomy and percutaneous endoscopic gastrostomy. The early postoperative neurosurgical patient continues to require a high degree of clinical vigilance. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Bapat, Smita, Luoma, Astri M.V.

المصدر: Anaesthesia & Intensive Care Medicine; Dec2016, Vol. 17 Issue 12, p613-618, 6p

مستخلص: Neurosurgery encompasses a wide range of established intracranial and spinal procedures as well as rapidly advancing techniques in areas such as functional neurosurgery, interventional radiology and magnetic resonance imaging (MRI). This article focuses on the required preoperative preparation of neurosurgical patients. Intracranial and spinal surgery are associated with significant morbidity (23.6% and 11.2%, respectively), with overall 30-day mortality around 0.4–2.3% for intracranial surgery. Preoperative assessment must consider the surgical procedure being undertaken, pathology and its presentation, as well as patient-related factors that can be optimized prior to surgery. It also allows preoperative risk stratification and shared decision-making, informed consent and appropriate planning of perioperative care. Careful documentation of preoperative neurological status is essential for postoperative assessment and management. A thorough understanding of the impact of surgery and anaesthesia on intracranial physiology is also required. This ensures high quality, safe care and excellent patient experience. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Luoma, Astri M.V., Clarke, Simon G.

المصدر: Anaesthesia & Intensive Care Medicine; Aug2011, Vol. 12 Issue 8, p343-346, 4p

مصطلحات موضوعية: INTUBATION, FIBER optics, ASPIRATORS, CONSCIOUS sedation, AIRWAY (Anatomy), SURGICAL complications, OPERATIVE surgery

مستخلص: Abstract: Fibreoptic intubation was first described as a technique in 1967. It may be performed awake or asleep, and can be used for airway management of a patient at risk of aspiration with a known or predicted difficult airway. This article describes the variety of methods available for awake and asleep fibreoptic intubation, as well as techniques for anesthetizing the airway. [Copyright &y& Elsevier]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)