Neurologic complications of anesthesia

Rabinstein, Alejandro A.; Keegan, Mark T.

doi:10.1212/cpj.0b013e3182a1b9bd

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…During the surgical procedure of removing an ailing liver and inserting a healthy one, there is a risk for hypotension, blood loss (hypovolemia), cerebral hypoperfusion, blood transfusion, ischemia, gas embolism and electrolyte correction (hyponatremia) [28,32,39]. These intraoperative factors could impact the brain, causing alterations of cerebrovascular system, seizures, ischemic or hemorrhagic stroke, osmotic demyelination syndrome, and encephalopathy [16,17,39,40]. In addition, general anesthesia during surgery can precipitate post-operative long-term cognitive dysfunction via oxidative stress and neuronal apoptosis, [41] which may contribute to neurological complications after LT.…”

Section: Intra-operative Factors and Neurological Complicationsmentioning

confidence: 99%

Hepatic Encephalopathy: From Metabolic to Neurodegenerative

2021

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome of both acute and chronic liver disease. As a metabolic disorder, HE is considered to be reversible and therefore is expected to resolve following the replacement of the diseased liver with a healthy liver. However, persisting neurological complications are observed in up to 47% of transplanted patients. Several retrospective studies have shown that patients with a history of HE, particularly overt-HE, had persistent neurological complications even after liver transplantation (LT). These enduring neurological conditions significantly affect patient's quality of life and continue to add to the economic burden of chronic liver disease on health care systems. This review discusses the journey of the brain through the progression of liver disease, entering the invasive surgical procedure of LT and the conditions associated with the post-transplant period. In particular, it will discuss the vulnerability of the HE brain to peri-operative factors and post-LT conditions which may explain non-resolved neurological impairment following LT. In addition, the review will provide evidence; (i) supporting overt-HE impacts on neurological complications post-LT; (ii) that overt-HE leads to permanent neuronal injury and (iii) the pathophysiological role of ammonia toxicity on astrocyte and neuronal injury/damage. Together, these findings will provide new insights on the underlying mechanisms leading to neurological complications post-LT.

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Section: Intra-operative Factors and Neurological Complicationsmentioning

confidence: 99%

Hepatic Encephalopathy: From Metabolic to Neurodegenerative

2021

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“…14 While general anaesthesia for hand surgery includes a subject with a block, disabled to do motor function in the arm, and with the subject either sedated or intubated, unable to follow the surgeon's instructions during the procedure. 15,16 Hence in the present research, we have assessed the difference in functional outcomes regarding the range of motion in the WALANT group versus general anaesthesia for tendon repair surgeries.…”

Section: Discussionmentioning

confidence: 99%

Wide Awake Local Anesthesia no Tourniquet (WALANT) Surgery for Tendon Repair in Hand Trauma

Kiran

Khan

Hyder

et al. 2022

PAFMJ

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Objective: To compare the functional outcomes in terms of active range of motion for tendon repair surgeries under wideawake local anaesthesia versus general anaesthesia. Study design: Comparative prospective study. Place and Duration of Study: Department of Plastic & Reconstructive Surgery, Dr Ruth K.M. Pfau Civil Hospital Karachi Pakistan, from Jan to Sep 2020. Methodology: Patients of either gender of age 15 years or above with hand injuries with tendon repair required, operated within the hospital premises were included in the study using the non-probability consecutive sampling technique. Individuals who were operated on under wide-awake local anaesthesia were taken as approach arms (n=65). While the patients undergoing tendon repair under general anaesthesia were considered as the study's control arm (n=65). The final functional outcomes were assessed in the sixth week of the surgery by calculating the total active range of motion. Results: For the range of motion of the injured finger in the general anaesthesia group, 25 (38.5%) had excellent outcomes, 14 (21.5%) had a good outcome, and 8 (12.3%) had fair outcomes, while in the WALANT group, 30 (46.2%) had excellent outcome, 16 (24.6%) had a good outcome and 12 (18.5%) had a fair outcome. There was no relationship between the range of motion of the injured finger and the group (p=0.101). Conclusion: The functional outcomes in active range of motion are better in the WALANT approach than in general anaesthesia.

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“…Perioperative seizure is rare in non-neurological surgeries. Risk factors include history of seizure disorders, previous brain injuries, and substance abuse 17 . Seizures can be classified into convulsive and nonconvulsive.…”

Section: Presentation Of Neurological Emergenciesmentioning

confidence: 99%

“…Risk factors include history of seizure disorders, previous brain injuries, and substance abuse. 17 Seizures can be classified into convulsive and nonconvulsive. In convulsive seizures, patients present with rhythmic jerking of the extremities, which can be associated with altered mental status including coma, lethargy, or confusion.…”

Section: Seizurementioning

confidence: 99%

Acute perioperative neurological emergencies

Lam

Luoma

Reddy

2023

International Anesthesiology Clinics

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Perioperative neurological complications can be a result of anesthesia or surgical procedures. Both surgery and anesthesia increases the risk of neurological sequelae due to ischemia, hemorrhage, hypoxia, or metabolic disorder (Table 1). [1][2][3][4][5][6][7][8][9][10] The impact can be devastating, leading to morbidity, increased length of stay, impaired quality of life, and mortality. [11][12][13] During anesthesia, there is no standard monitoring for the neurological system compared with other organs (eg, electrocardiograph and blood pressure for the cardiovascular system, pulse oximetry, and capnography for the respiratory system). When patients present with neurological signs and symptoms perioperatively, early assessment and imaging is needed to facilitate prompt diagnosis and management.This article will provide an overview of common neurological complications in the perioperative period. To cover details of all neurological emergencies will be beyond the scope of this article. We will focus on common emergencies in general surgery with a brief discussion of neurological complications in specific surgical populations. The common presentation of these complications will be explored, followed by the diagnosis and management of these pathologies. Presentation of neurological emergencies Focal neurological deficitNeurological deficit can be caused by injury to the brain, spinal cord, or peripheral nerves. Careful neurological examination and interpretation with clinical context is needed to identify the possible site of injury and arrive at the correct diagnosis. Common causes of neurological deficit with corresponding physical findings is summarized in Table 2.

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Neurologic complications of anesthesia

Cited by 9 publications

References 23 publications

Hepatic Encephalopathy: From Metabolic to Neurodegenerative

Hepatic Encephalopathy: From Metabolic to Neurodegenerative

Wide Awake Local Anesthesia no Tourniquet (WALANT) Surgery for Tendon Repair in Hand Trauma

Acute perioperative neurological emergencies

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