Shashi Srivastava

Pain following Craniotomy: Reassessment of the Available Options

Pain following craniotomy has frequently been neglected because of the notion that postcraniotomy patients do not experience severe pain. However a gradual change in this outlook is observed because of increased sensitivity of neuroanaesthesiologists and neurosurgeons toward acute postcraniotomy pain. Multiple modalities exist for treating this variety of pain each with its own share of advantages and disadvantages. However, individually none of these modalities has been proclaimed as the best and applicable universally. A considerable amount of dispute remains to ascertain the appropriate therapeutic regimen for treating postcraniotomy pain in spite of numerous trials using different drugs and their combinations. This review aims to highlight the genesis, characteristics, and different strategies that are undertaken for management of acute postcraniotomy pain. Chronic postcraniotomy pain which can be debilitating sequelae is also discussed concisely.

Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double-blind, controlled study.

Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I–II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.

Intense Intraoperative Thirst: A Neglected Concern during Awake Craniotomy Surgeries.

Cyrill Meuwly, MMed* Tumul Chowdhury, MD, DM, FRCPCw Ricardo Gelpi, MD, PhDz Paul Erne, MD* Bernhard Schaller, MD, PhD, DSCy *Department of Research, University Hospital Basel, Basel, Switzerland wDepartment of Anaesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, Canada zDepartment of Pathology, University of Buenos Aires, Buenos Aires, Argentina yDepartment of Research, University of Southampton, Southampton, UK

Effect of two different doses of dexmedetomidine on stress response in laparoscopic pyeloplasty: A randomized prospective controlled study

Background: Clonidine, opioids, β-blockers, and dexmedetomidine have been tried to attenuate stress responses during laparoscopic surgery. We evaluated the efficacy of dexmedetomidine in two different doses in attenuating stress responses on patients undergoing laparoscopic pyeloplasty. Subjects and Methods: Ninety patients were assigned to one of the three groups: Group A, Group B, and Group C. Group B received dexmedetomidine 1 mcg/kg as loading dose, followed by 0.7 mcg/kg/h for maintenance; Group C received dexmedetomidine 0.7 mcg/kg as a loading dose, followed by 0.5 mcg/kg/h for maintenance. Group A received normal saline. Stress responses were assessed by the variations in heart rate (HR), mean arterial pressure (MAP), blood glucose levels, and serum cortisol levels. One-way analysis of variance test was applied. Multiple comparisons between groups were done with post hoc Bonferroni test. Results: The HR and MAP were found to be higher in Group A. The difference was statistically significant (P < 0.05) during intubation, carbon dioxide insufflation, and extubation when compared with Groups B and C. Blood glucose levels at postintubation and at extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. Serum cortisol levels at postintubation, during midsurgery, and 2 h after extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. However, HR, MAP, blood glucose levels, and serum cortisol levels were similar in dexmedetomidine groups. Conclusions: Dexmedetomidine decreases stress response and provides good condition for maintenance of anesthesia. Dexmedetomidine when used in lower dose in Group C decreases stress response comparable to higher dose in Group B.

Valsalva maneuver: Its implications in clinical neurosurgery

Valsalva maneuver is associated with diverse physiological changes. These changes are used in various diagnostic and therapeutic clinical settings. Valsalva maneuver is also employed during various phases of neurosurgical procedures to achieve specific targets and confirm intraoperative findings. In this article, we attempt to describe the various clinical applications of the Valsalva maneuver within the realms of clinical neurosurgery. The associated complications of this act have also been discussed.

Contemporary social network sites: Relevance in anesthesiology teaching, training, and research

Objective: The phenomenal popularity of social networking sites has been used globally by medical professionals to boost professional associations and scientific developments. They have tremendous potential to forge professional liaisons, generate employment,upgrading skills and publicizing scientific achievements. We highlight the role of social networking mediums in influencing teaching, training and research in anaesthesiology. Background: The growth of social networking sites have been prompted by the limitations of previous facilities in terms of ease of data and interface sharing and the amalgamation of audio visual aids on common platforms in the newer facilities. Review: Contemporary social networking sites like Facebook, Twitter, Tumblr,Linkedn etc and their respective features based on anaesthesiology training or practice have been discussed. A host of advantages which these sites confer are also discussed. Likewise the potential pitfalls and drawbacks of these facilities have also been addressed. Conclusion: Social networking sites have immense potential for development of training and research in Anaesthesiology. However responsible and cautious utilization is advocated.

Paediatric Intravenous Splint: A Cause of Pressure Injury during Neurosurgery in Prone Position

Splint application avoids unwanted movement of limbs and kinking of intravenous catheters in infants, allowing free flow of intravenous fluids. However, if placed in contact with dependent surfaces during prone surgeries, they have the propensity to cause inadvertent pressure injuries. This occurs due to the weight of the limb and continuous friction and is augmented by a rise in the local temperature and perspiration. We wish to share our experience of such an unintentional injury caused by a paediatric intravenous splint.

Use of desflurane in neurosurgery: Cons

Desflurane is being projected nowadays as inhalational agent of choice in the repertoire of the modern day anaesthesiologists. Refinement of its pharmacologic properties from its predecessors has attracted the attention of clinicians towards this novel agent. However, within the realms of neurosurgical anaesthesiology, the widespread use of desflurane today should be, at best viewed with a bit of caution. Although a sizeable number of advantages of using desflurane exist, anaesthesiologists dealing with neurosurgical patients should be cognizant of its drawbacks.

Standardising training in neuroanaesthesia in India: Picking up the gauntlet

and regulation based on proven or widely accepted principles.[1] Regulations are drawn with regard to training and qualification of professionals dealing with operative procedures and perioperative care. Standardisation ensures uniformity of the quality of patient care, brings it at par with international standards and also leads to reduction in human errors, thereby increasing the overall patient safety. In the absence of standardised training, conflicting patterns of patient care cause clinical dilemmas whose resolution becomes difficult. In this context, the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) can play a stellar role and is the torchbearer of formulating the guiding principles which govern the training methodologies across the various institutes. The introduction of PDF courses being conducted at different centres across the country under the aegis of ISNACC is the foundation steps in this direction. Unlike the European and American courses, where the system of accreditation ensures that the necessary requirements for sub‐speciality fellowships and training are being constantly monitored at the organisational levels by authorised professional bodies, we are yet to have such bodies. Another approach towards this direction can be the introduction of ‘Credit Systems’. Worldwide, credit system is the watchword of numerous international training programmes.[2] Credit-based certification systems ensure certain points for every level of learning and assessment throughout the duration the course. Thus, the achievement of standardised professional objectives is made certain based on the credits accumulated by the trainees.

An unusual cause of unilateral facial injuries caused by horseshoe headrest during prone positional craniovertebral junction surgery.

Pressure injuries are an accepted complication of prone positioning during the neurosurgical procedures. Horseshoe headrest are intended to reduce the incidence and severity of such injuries by allowing limited areas of contact between the skin of dependent areas of contact and the supporting surfaces. We report a case where a patient positioned prone over a horseshoe headrest developed inadvertent unilateral facial pressure injuries following a 6-h long craniovertebral junction (CVJ) surgery. We attempt to highlight this complication, analyze its causation, and briefly review the existing literature related to similar reported injuries.