Experience with IONM, the use of an adequate IONM modality, and knowledge of the effect of anesthetic techniques and agents on neurophysiological parameters are fundamental for reliable measurements. The current gold standard in IONM is total intravenous anesthesia without neuromuscular block.

Purpose Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain. Patients and Methods GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis. Results Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD −2.14, 95% CI −2.65 to −1.63; p<0.00001) and after 30 days after the end of treatment with ketamine (MD −1.68, 95% CI −2.25 to −1.12; p<0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p<0.00001). Conclusion There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review.

No abstract

Cardiac arrest in unusual positions represents an additional challenge for anesthesiologists. This paper reports a successful cardiopulmonary resuscitation during neurosurgical procedure in which high-quality chest compressions was performed in the prone position. The aim of this report is disclose the knowledge of resuscitation maneuvers in a position other than supine. A 77-year-old female patient presented for excision of parietal-occipital meningioma in the prone position with the head fixed on a Mayfield head-holder. During the surgical procedure the sagittal sinus was disrupted. The patient presented an abrupt hemorrhagic shock leading to a cardiac arrest by hypovolemia despite vigorous volume replacement. Cardiac massage was promptly initiated in the prone position. After two minutes, there was a return of spontaneous circulation. The patient was discharged without sequelae. We concluded that high-quality chest compressions in the prone position were able to generate sufficient cardiac output.