The preoperative assessment of the patient for neurosurgical and endovascular procedures involves the understanding of the neurological disease and its systemic presentation, and the requirements of the procedure. There is a wide spectrum of different neurosurgical disorders and procedures. This article provides an overview of the preoperative evaluation of these patients with respect to general principles of neuroanesthesia, and considerations for specific intracranial and vascular neurosurgical and interventional neuroradiological procedures.

Vanitha Sivanaser

Pirjo Manninen

Preoperative Assessment of Adult Patients for Intracranial Surgery

<i  >Aim</i>. The aim of this study is to compare the clinical feasibility of Macintosh and Miller laryngoscopes for tracheal intubation in non-experienced users in anesthetized patients. <i  >Patients and Methods</i>. 119 patients were randomized into the Macintosh group (59) and the Miller group (60). The primary outcome variable was successful tracheal intubation. The secondary outcome variables were number of insertion attempt, intubation time needed, total time to intubation, hemodynamic change and complications. <i  >Results</i>. All patients were successfully intubated using the Macintosh, whereas 13 patients (21.6&#x25;) were failed with the Miller (<svg style="vertical-align:-0.30096pt;width:56.150002px;" id="M1" height="11.0625" version="1.1" viewBox="0 0 56.150002 11.0625" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
		<g transform="translate(72,-63.15)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>). The Macintosh significantly reduced the mean total time to intubation (<svg style="vertical-align:-0.30096pt;width:56.150002px;" id="M2" height="11.0625" version="1.1" viewBox="0 0 56.150002 11.0625" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
		<g transform="translate(72,-63.15)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>). There were significant differences in the mean blood pressure at 2 minutes after laryngoscope insertion, immediately, and 2 minutes after tracheal intubation and in the mean heart rate at the laryngoscope insertion, immediately, and at 2 minutes after tracheal intubation between the two groups. Overall complications in both were not significantly different. <i  >Conclusion</i>. Orotracheal intubation using the Macintosh is an effective and safe technique in non-experienced hands with significantly increased success rate as well as decreased mean total time to intubation as compare to the Miller. However, these intubations only apply to selected patients deemed to have normal airways.

Somchai Amornyotin

Ungkab Prakanrattana

Phongthara Vichitvejpaisal

Thantima Vallisut

Neunghathai Kunanont

Ladda Permpholprasert

Comparison of the Clinical Use of Macintosh and Miller Laryngoscopes for Orotracheal Intubation by Second-Month Nurse Students in Anesthesiology

The aim of this survey was to review cesarean delivery anesthetic practices. An online survey was sent to members of the Society of Obstetric Anesthesia and Perinatology (SOAP). The mode of anesthesia, preferred neuraxial local anesthetic and opioid agents, postoperative analgesic regimens, and monitoring modalities were assessed. 384 responses from 1,081 online survey requests were received (response rate = 36&#37;). Spinal anesthesia is most commonly used for elective cesarean delivery (85&#37; respondents), with 90&#37; of these respondents preferring hyperbaric bupivacaine 0.75&#37;. 79&#37; used intrathecal fentanyl and 77&#37; used morphine (median [range] dose 200&#x2009;mcg [50&#8211;400]). 91&#37; use respiratory rate, 61&#37; use sedation scores, and 30&#37; use pulse oximetry to monitor for postoperative respiratory depression after administration of neuraxial opioids. Postoperative analgesic regimens include: nonsteroidal anti-inflammatory agents, acetaminophen, oxycodone, and hydrocodone by 81&#37;, 45&#37;, 25&#37;, and 27&#37; respondents respectively. The majority of respondents use spinal anesthesia and neuraxial opioids for cesarean delivery anesthesia. There is marked variability in practices for monitoring respiratory depression postdelivery and for providing postoperative analgesia. These results may not be indicative of overall practice in the United States due to the select group of anesthesiologists surveyed and the low response rate.

Leinani Aiono-Le Tagaloa

Alexander J. Butwick

Brendan Carvalho

A Survey of Perioperative and Postoperative Anesthetic Practices for Cesarean Delivery

Central neuropathic pain is difficult to treat, but delta 9-Tetrahydrocannabinol (delta 9-THC) may be a promising therapeutic agent. We administered in 172 patients on average 7.5 mg delta 9-THC over 7 months. Of these, 48 patients prematurely withdrew due to  side effects, insufficient analgesia, or expense of therapy. Thus, 124 patients were assessed retrospectively in a multicenter telephone survey. Reported changes in pain intensity, recorded on a numeric  rating scale (NRS), Pain Disability Index (PDI), Medical Outcomes Short-Form (SF-12), Quality of Life Impairment by Pain (QLIP), Hospital Anxiety Depression Scale (HADS), and amount of concomitant pain medication were recorded. Psychometric parameters (PDI, SF-12, QLIP, HADS) and pain intensity improved significantly during delta 9-THC treatment. Opioid doses were reduced and patients perceived THC therapy as effective with tolerable side effects. About 25% of the patients, however, did not tolerate the treatment. Therapy success and tolerance can be assessed by a transient delta 9-THC titration and its maintained administration for several weeks. The present survey demonstrates its ameliorating potential for the treatment of chronic pain in central neuropathy and fibromyalgia. A supplemental delta 9-THC treatment as part of a broader pain management plan therefore may represent a promising coanalgesic therapeutic option.

Janet Weber

Marcus Schley

Matthias Casutt

Helmut Gerber

Guido Schuepfer

Roman Rukwied

Wolfgang Schleinzer

Michael Ueberall

Christoph Konrad

Tetrahydrocannabinol (Delta 9-THC) Treatment in  Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future.

Eric L. Bloomfield

The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

The aim of this study was to compare the hemodynamic and ventilatory effects of prolonged infrarenal aortic cross-clamping in pigs undergoing either laparotomy or laparoscopy.
18 pigs were used for this study. 
Infrarenal aortic crossclamping was performed for 60 minutes in groups
 I (laparotomy, <svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M1" height="11.225" version="1.1" viewBox="0 0 36.237499 11.225" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.963)"><path id="x1D45B" d="M495 86q-46 -47 -87 -72.5t-63 -25.5q-43 0 -16 107l49 210q7 34 8 50.5t-3 21t-13 4.5q-35 0 -109.5 -72.5t-115.5 -140.5q-21 -75 -38 -159q-50 -10 -76 -21l-6 8l84 340q8 35 -4 35q-17 0 -67 -46l-15 26q44 44 85.5 70.5t64.5 26.5q35 0 10 -103l-24 -98h2&#xA;q42 56 97 103.5t96 71.5q46 26 74 26q9 0 16 -2.5t14 -11.5t9.5 -24.5t-1 -44t-13.5 -68.5q-30 -117 -47 -200q-4 -19 -3.5 -25t6.5 -6q21 0 70 48z" /></g><g transform="matrix(.017,-0,0,-.017,13.305,10.963)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,28.008,10.963)"><path id="x36" d="M137 343l67 33q37 17 63 17q79 0 129.5 -53t50.5 -131q0 -92 -58 -156.5t-147 -64.5t-147 68t-58 182q0 63 17 119t43 95.5t61.5 72t69 52t67.5 31.5q62 22 128 33l6 -32q-56 -11 -108 -35q-149 -71 -184 -231zM227 337q-47 0 -95 -27q-6 -23 -6 -70q0 -93 36 -155.5&#xA;t96 -62.5q53 0 78 45.5t25 105.5q0 68 -35 116t-99 48z" /></g>

		
	
</svg>) and II (laparoscopy, <svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M2" height="11.225" version="1.1" viewBox="0 0 36.237499 11.225" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.963)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.963)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.963)"><use xlink:href="#x36"/></g>

		
	
</svg>). Group III (laparoscopy, <svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M3" height="11.225" version="1.1" viewBox="0 0 36.237499 11.225" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.963)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.963)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.963)"><use xlink:href="#x36"/></g>

		
	
</svg>) underwent a 120-minute long pneumoperitoneum in absence of aortic clamping (sham group). 
 Ventilatory and hemodynamic parameters and renal function were serially determined in all groups. 
A significant decrease in pH and significant increase in <svg     style="vertical-align:-3.27605pt;width:47.237499px;" id="M4" height="15.5125" version="1.1" viewBox="0 0 47.237499 15.5125" width="47.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><path id="x50" d="M46 650h247q112 0 169 -41q64 -49 64 -141q0 -91 -56.5 -143t-138.5 -62q-23 -3 -45 -1l-74 19v-157q0 -63 15.5 -77t83.5 -19v-28h-271v28q60 5 74 20t14 77v400q0 65 -12.5 79t-69.5 18v28zM212 559v-245q31 -12 73 -12q59 0 102 38t43 124q0 77 -42.5 115.5&#xA;t-108.5 38.5q-44 0 -56 -12q-11 -8 -11 -47z" /></g><g transform="matrix(.017,-0,0,-.017,9.259,11.363)"><path id="x61" d="M433 39l-85 -51q-27 0 -47 20q-16 16 -24 44q-5 -3 -24 -16.5t-27 -18.5t-23 -13.5t-25 -12t-19 -3.5q-52 0 -86 36.5t-34 85.5q0 71 81 99q128 43 155 65v17q0 54 -23 83.5t-62 29.5q-28 0 -45 -19t-29 -66q-7 -23 -29 -23q-15 0 -29 13t-14 30t31 40q25 19 68.5 40.5&#xA;t81.5 29.5q49 0 82 -27q45 -39 45 -123v-185q0 -60 35 -60q18 0 36 11zM275 84v156q-12 -6 -49 -23t-41 -19q-31 -14 -46 -31t-15 -43q0 -35 22.5 -55.5t48.5 -20.5q19 0 42 10.5t38 25.5z" /></g><g transform="matrix(.017,-0,0,-.017,16.721,11.363)"><path id="x43" d="M614 175l29 -10q-33 -109 -57 -154q-121 -26 -184 -26q-90 0 -160.5 29t-112.5 77t-63.5 105.5t-21.5 119.5q0 157 108 253t277 96q36 0 71.5 -5t69 -13.5t36.5 -8.5q15 -102 20 -150l-29 -8q-20 79 -66.5 114t-128.5 35q-119 0 -187.5 -86t-68.5 -207&#xA;q0 -140 73.5 -227.5t188.5 -87.5q73 0 119.5 37.5t86.5 116.5z" /></g><g transform="matrix(.017,-0,0,-.017,28.127,11.363)"><path id="x4F" d="M381 665q131 0 226.5 -93t95.5 -239q0 -158 -96 -253t-238 -95q-137 0 -231 95t-94 238q0 142 92.5 244.5t244.5 102.5zM359 629q-89 0 -151 -74.5t-62 -208.5q0 -141 69 -233t175 -92q90 0 150.5 74t60.5 211q0 152 -69 237.5t-173 85.5z" /></g>

			<g transform="matrix(.012,-0,0,-.012,40.838,15.45)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g>

		
	
</svg> were observed in group II, whereas no changes in these parameters were seen in group I and III. All variables returned to values similar to baseline in groups I and II 60 minutes after declamping. A significant increase in renal resistive index was evidenced during laparoscopy, with significantly higher values seen in Group II. 
Thus a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause decreased renal perfusion and acidosis, thus negatively affecting the patient&#x27;s general state during this type of surgery.

María F. Martín-Cancho

Verónica Crisóstomo

Federico Soria

Carmen Calles

Francisco M. S&#xe1;nchez-Margallo

Idoia Díaz-Güemes

Jesús Usón-Gargallo

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Acquired acute demyelinating peripheral polyneuropathy (AADP) is a general classification of pathologies that could affect secondary the peripheral nervous system. They are characterized by an autoimmune process directed towards myelin. Clinically they are characterized by progressive weakness and mild sensory changes. Acute inflammatory demyelinating polyneuropathy often is referred to as Guillain-Barré syndrome (GBS). GBS is the major cause of acute nontraumatic paralysis in healthy people and it is caused by autoimmune response to viral agents (influenza, coxsackie, Epstein-Barr virus, or cytomegalovirus) or bacterial infective organisms (Campylobacter jejuni, Mycoplasma pneumoniae). A detailed history, with symptoms of progressive usually bilateral weakness, hyporeflexia, with a typical demyelinating EMG pattern supports the diagnosis. Progressive affection of respiratory muscles and autonomic instability coupled with a protracted and unpredictable recovery normally results in the need for ICU management. We present a case report of a patient with a typical GBS presentation but with a unilateral upgoing plantar reflex (Babinski sign). A unifying diagnosis was made and based on a literature search in Pubmed appears to be the first described case of its kind.

Davide Cattano

Brian O'connor

Ra'ad Shakir

Francesco Giunta

Mark Palazzo

Acute Inflammatory Demyelinating Polyneuropathy and a Unilateral Babinski/Plantar Reflex

About this journal

<p><em>Anesthesiology Research and Practice </em>provides a forum for health care professionals engaged in perioperative medicine, critical care, and pain management. Topics include anesthetic administration, preoperative and postoperative considerations etc.</p>


Journal profile

Meet the editorial board

<p><em>Anesthesiology Research and Practice </em>maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.</p>


Editor spotlight

Submit your proposal

Do you think there is an emerging area of research that really needs to be highlighted? Or an existing research area that has been overlooked or would benefit from deeper investigation? Raise the profile of a research area by leading a Special Issue.

Special Issues

Author guidelines

Editorial board

Databases and indexing

Anesthesiology Research and Practice - Table of contents

Anesthesiology Research and Practice | Hindawi

title

Anesthesiology Research and Practice provides a forum for health care professionals engaged in perioperative medicine, critical care, and pain management. Topics include anesthetic administration, preoperative and postoperative considerations etc.

Anesthesiology Research and Practice