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Brain tumors are the second most common malignancy in childhood and the surgical excision remains the cornerstone of management. The objective of this study was to analyze the factors associated with the length of intensive care unit (ICU) and hospital stay, and postoperative outcome in such children.Three years of data were collected, retrospectively, by detailed review of medical records pertaining to pre-anesthetic evaluation and perioperative course of children less than 16 years of age who underwent excision of intracranial tumors.One hundred sixty-eight medical records were analyzed. One third of the children were found to have developed various intraoperative adverse events; the most common were hemodynamic changes following brainstem handling and brain swelling. 58% of children required postoperative mechanical ventilation. 82.7% of patients had favorable neurologic outcome which was comparable between the two tumor locations (supratentorial vs infratentorial). On multivariate analysis, re-exploration surgery and electrolyte disturbances, such as serum sodium, were found to be the independent risk factors affecting hospital stay. The amount of intraoperative blood loss and postoperative pulmonary complications (POPCs) were independent risk factors affecting the neurologic outcome.Adverse events are fairly common after excision of brain tumors in children. Intraoperative complications did not affect the ICU stay or neurological outcome; however, the postoperative complications increased length of ICU and hospital stays. POPC was the single most important factor responsible for poor neurologic outcome and was more so in children who underwent infratentorial surgery, prolonged mechanical ventilation, and who had a lower cranial nerve palsy.

A patient with coronavirus disease-2019 (COVID-19) developed bilateral subcutaneous emphysema involving the neck and upper chest following the institution of non-invasive ventilation (NIV) for worsening hypoxia. We discuss the various causes, differentials and successful management of this patient.

β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.

Artificial intelligence (AI) already influences almost every sector of our daily life, including the rapidly evolving technologies and datasets of healthcare delivery. The applications in medicine have significantly evolved over the past few decades and have shown promising results. Despite constant efforts to incorporate AI into the field of anesthesiology since its inception, it is still not commonplace. Neuroanesthesiology and neurocritical care is a discipline of medicine that deals with patients having disorders of the nervous system comprising a complex combination of both medical and surgical disease conditions. AI can be used for better monitoring, treatment, and outcome prediction, thereby reducing healthcare costs, minimizing delays in patient management, and avoiding medical errors. In this review, we have discussed the applications of AI and its potential in aiding the clinician’s judgment in several aspects of neuroanesthesiology and neurocritical care, some of the barriers to its implementation, and the future trends in improving education in this field, all of which will require further work to understand its exact scope.

Currently, COVID-19 is spreading rapidly and presenting with different clinical features with different mortality rates worldwide. In the initial days of the pandemic, most of the patients presented with the complaints of lower respiratory tract infection of varying severity, and most of the deaths were also attributable to respiratory failure. As time progressed, more atypical presentations and causes of mortality were encountered according to different age groups. In the present scenario, a surge of COVID-19 cases is expected. Those new cases will also include patients with various problems requiring surgical interventions. In this brief review, we have discussed various presentations and mortality risks of COVID-19 infections in different age groups. We did literature searched on the PubMed database and included studies published in 2019 and 2020. Altogether, 503 articles were retrieved out of which 31 were analyzed to put up this summary. Important atypical findings in neonates and infants were axial hypotonia, drowsiness, moaning sound, intussusception, and late-onset neonatal sepsis with the cause of death being multi-organ failure. Frequently reported comorbidities among children were hydronephrosis, leukemia, and intussusception. Observed risk factors for unfavorable outcome in the adult population were obesity, HIV, tuberculosis, and the intake of immunosuppressive agents in the form of anticancer drugs and steroids. The factors adding to the vulnerability in the elderly population could be enumerated as diabetes, hypertension, ischemic heart diseases, obesity, and cancers.

Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

Fever occurs commonly in patients admitted to the neurocritical care unit. An increase in the body temperature is known to have deleterious effects on patients with acute nervous system injury and in most cases is associated with an increase in mortality and morbidity of these patients. There are multiple causes of fever in these patients. Due to the potentially devastating effects of fever in patients with cerebral diseases, it warrants treatment in every case. In all patients with acute cerebral damage, treatment of fever and maintenance of euthermia is important to obtain a better functional recovery and to limit any further secondary insult to the brain. This review highlights the etiology and pathophysiology of fever in neurocritical care unit patients, the effects on various organ systems and associated systemic complications, and the evaluation and different therapeutic options available for the management of fever in this patient subset.

The pediatric age group includes a wide spectrum ranging from neonates, infants to adolescents, each group having unique physiology to understand. Due to the anatomical, physiological, and pathological differences, children present as a heterogeneous group, especially during the first 8 years of life. The nervous system of children is profoundly different during the various stages of childhood and from adults. The central nervous system (CNS) is incompletely developed at birth and continues to grow and mature till the second year of life. The proportion of cerebral blood flow is highest in children between 1 and 3 years, about 40–50% of the cardiac output, increasing their vulnerability to cerebral ischemia during periods of systemic hypotension. Though cerebral autoregulation and CO2 reactivity are preserved even in preterm and term neonates, their immature neurons are extremely vulnerable to adverse events like sudden physiological perturbations and the influences of toxic substances. This warrants the need to maintain homeostasis as closely as possible and the institution of neuroprotective strategies and treatment. Sound knowledge of the unique neurodevelopmental events and neurophysiological principles applicable to the pediatric population is paramount for the safe and effective perioperative care of infants and children at risk for neurological injury.

Positioning refers to the body position in which a patient is placed for a surgical procedure. The optimal patient position should facilitate maximum surgical access with minimum physiologic perturbations or physical injury without compromising patient safety. The fundamental considerations about the position for neurosurgery aim to (a) provide the most acceptable access to the anatomical target, ensuring the comfort of the surgeon and patient and access to the anesthesiologist and adequate access for monitoring, (b) avoid brain retraction, (c) minimize intraoperative bleeding, (d) reduce intracranial pressure (ICP), (e) ensure adequate cerebral perfusion, (f) prevent compression or traction injuries (skin dehiscence, ocular injuries, peripheral nerve injuries), and (g) increase the likelihood of a successful surgery with a good outcome. The optimum positioning of children for neurosurgery poses unique challenges due to the anatomical and physiological differences and the age-wise variations in surgical lesions. Safe and comfortable positioning of the pediatric patient is of paramount importance. Knowledge, planning, and teamwork are the major components of attentive positioning, which fulfils the aim of the surgical procedure and prevents the ensuing complications, thereby reducing perioperative morbidity. This chapter describes the special considerations for positioning pediatric patients for the commonly performed neurosurgical procedures in commonly used positions (supine, lateral, prone, sitting) and their variations, how the position is established, associated complications, and measures to mitigate these complications.

Objective: Transcutaneous electrical nerve stimulation (TENS) is a common modality used to treat acute and chronic painful conditions. The aim of this study is to find out the effect of immediate preoperative TENS on intraoperative anesthetic drug consumption in patients undergoing lumbar discectomy under general anesthesia. Methods: Sixty patients undergoing lumbar discectomy were randomly divided into two study groups. In TENS group (Group T), TENS was applied for 1 h in the immediate preoperative period with 20 mA current, at 100 Hz frequency, in pulses of 250 μs on either side of the planned incision site. In Sham TENS group (Group S), TENS was applied for 1 h preoperatively to the patients, although with the current intensity set at “zero” mA. The pain intensity during rest as well as movement was recorded before and after TENS, by using the Visual Analog Scale (VAS) scores in both the groups. Intraoperatively, titrated doses of propofol were used to maintain a bispectral index value of 50 ± 5, and IV fentanyl was administered to maintain the heart rate and blood pressure within 20% of baseline values. Postoperatively, fentanyl 0.5 μg/kg IV was administered to achieve VAS of

Introduction: Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known. Materials and Methods: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients with CRPS type II undergoing surgery for repair of brachial plexus injury were randomized (1:1) to receive SGB with either 10 mL of 0.5% bupivacaine (Group B) or a matching placebo (Group S) before induction of anesthesia. Results: There was a significant reduction in the requirement of total intraoperative propofol (1659.7 ± 787.5 vs. 2500.7 ± 740.9 mg, P = 0.0003) and fentanyl (190.0 ± 82.5 vs. 327.3 ± 139.3, P = 0.0001) in Group B compared with Group S. Similarly, in Group B, the time to first analgesic was much longer (328 ± 219 vs. 64 ± 116 min, P = 0.000) and postoperative fentanyl requirement for 24 h was lesser compared to Group S (0.6 ± 1.1 vs. 2.1 ± 1.3 μg/kg, P = 0.000). Conclusion: SGB is effective in reducing the requirement of intraoperative propofol and fentanyl as well as decreasing opioid requirement in the postoperative period in patients with CRPS type II undergoing surgery.

We report a patient who sustained catastrophic pulmonary fat embolism post-induction of general anesthesia during laparotomy for haemoperitoneum. The source being the fractured shaft of fracture femur which was missed during the primary survey in the chaos of a positive focused assessment with sonography for trauma and a transient responding patient. In this case report, we want to emphasize the importance of primary survey in a trauma patient, effective communication and documentation to prevent errors and for better management of patients.

The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described.