Position-dependent hemodynamic changes in neurosurgery patients: A narrative review

Emamimeybodi, Maryam; Hajikarimloo, Bardia; Abbasi, Fatemeh; Tavanaei, Roozbeh; Toudeshki, Kimia Karimi; Koohi, Narges; Pourhemmati, Sara; Amani, Hanieh; Pishgahi, Mahdi; Oraee-Yazdani, Saeed; Mortazavi, Martin M.; Zali, Alireza; Fahim, Farzan

doi:10.1016/j.inat.2023.101886

Cited by 3 publications

(2 citation statements)

References 89 publications

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“…Additionally, a narrative review published in the Annals of Rehabilitation Medicine focuses on hemodynamic considerations in the context of intraoperative neurophysiological monitoring during neuromuscular scoliosis surgery, emphasizing the relationship between hemodynamic parameters and neurophysiological changes [ 16 ]. Furthermore, the impact of position-dependent hemodynamic changes in neurosurgical patients is discussed in a review article, emphasizing the influence of patient positioning on intracerebral blood volume and ICP [ 17 ]. These sources underscore the importance of comprehensive hemodynamic management in neurosurgery, encompassing factors such as blood pressure, ICP, and cerebral blood flow to support optimal surgical outcomes and minimize the risk of hemodynamic disturbances.…”

Section: Reviewmentioning

confidence: 99%

“…Appropriate CPP is crucial in neurosurgery to ensure stable cerebral blood flow and prevent hemodynamic disturbances. Hemodynamic neurosurgery considerations encompass managing blood pressure, ICP, and cerebral blood flow to ensure optimal conditions for the brain during surgical procedures [ 17 , 20 ]. Several studies and articles discuss the impact of hemodynamic changes on neurosurgical patients, emphasizing the importance of monitoring and managing blood pressure and ICP levels to support cerebral perfusion [ 18 , 19 , 21 ].…”

Section: Reviewmentioning

confidence: 99%

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Cerebral Perfusion Unveiled: A Comprehensive Review of Blood Pressure Management in Neurosurgical and Endovascular Aneurysm Interventions

Petkar,

Chakole,

Nisal

et al. 2024

Cureus

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This comprehensive review delves into the intricate dynamics of cerebral perfusion and blood pressure management within the context of neurosurgical and endovascular aneurysm interventions. The review highlights the critical role of maintaining a delicate hemodynamic balance, given the brain's susceptibility to fluctuations in blood pressure. Emphasizing the regulatory mechanisms of cerebral perfusion, particularly autoregulation, the study advocates for a nuanced and personalized approach to blood pressure control. Key findings underscore the significance of adhering to tailored blood pressure targets to mitigate the risks of ischemic and hemorrhagic complications in both neurosurgical and endovascular procedures. The implications for clinical practice are profound, calling for heightened awareness and precision in hemodynamic management. The review concludes with recommendations for future research, urging exploration into optimal blood pressure targets, advancements in monitoring technologies, investigations into long-term outcomes, and the development of personalized approaches. By consolidating current knowledge and charting a path for future investigations, this review aims to contribute to the continual enhancement of patient outcomes in the dynamic field of neurovascular interventions.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Cerebral Perfusion Unveiled: A Comprehensive Review of Blood Pressure Management in Neurosurgical and Endovascular Aneurysm Interventions

Petkar,

Chakole,

Nisal

et al. 2024

Cureus

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Cerebrovascular pulsatility indicates preoperative subcortical cognitive impairment and an increased risk for postoperative delirium in elderly patients undergoing elective spine surgery

Saar,

Müller,

Veser

et al. 2024

Front. Med.

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IntroductionAdvances in spine surgery enable safe interventions in elderly patients, but perioperative neurocognitive disorders (pNCD), such as post-operative delirium (POD) and cognitive dysfunction (POCD), remain a serious concern. Pre-operative cognitive impairment is a major risk factor for pNCD. Comprehensive pre-operative cognitive assessments are not feasible in clinical practice, making effective screening methods desirable. This study investigates whether pre-operative cerebrovascular duplex sonography can assess subcortical (vascular) cognitive impairment and the risk for POD.MethodsThis prospective single-center study recruited patients aged ≥60 years scheduled for elective spine surgery at a German university hospital. Patients underwent pre-operative assessments including cognitive abilities (CERAD test battery), structural MRI, and cerebrovascular duplex sonography. POD screening was conducted three times daily for at least 3 days. The primary hypothesis, that the mean pulsatility index (PI) of both internal carotid arteries (ICA) predicts POD risk, was tested using logistic regression. Secondary analyses examined the association between POD risk and ICA flow (time-averaged peak velocities, TAPV) and correlations with cognitive profiles and MRI characteristics.ResultsPOD occurred in 22% of patients (n = 22/99) within three postoperative days. Patients with POD were significantly older (75.9 ± 5.4 vs. 70.0 ± 6.9 years, p < 0.01) but did not differ by gender (p = 0.51). ICA PI significantly predicted POD risk (OR = 5.46 [95%CI: 1.81–16.49], p = 0.003), which remained significant after adjustment for age and duration of surgery (ORadj = 6.38 [95% CI: 1.77–23.03], p = 0.005). TAPV did not inform the POD risk (p = 0.68). ICA PI Pre-operative cognitive scores were significantly associated with ICA PI (mean CERAD score: r = −0.32, p < 0.001). ICA PI was also significantly associated with total white matter lesion volume (τ = 0.19, p = 0.012) and periventricular white matter lesion volume (τ = 0.21, p = 0.007).DiscussionThis is the first study to demonstrate that cerebrovascular duplex sonography can assess the risk for POD in elderly spine surgery patients. Increased ICA PI may indicate subcortical impairment, larger white matter lesion load, and lower white matter volume, predisposing factors for POD. Pre-operative cerebrovascular duplex sonography of the ICA is widely available, easy-to-use, and efficient, offering a promising screening method for POD risk. Increased ICA PI could supplement established predictors like age to adjust surgical and peri-operative procedures to individual risk profiles.

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Outcomes and Complications of Posterior Fossa Surgery in Sitting Versus Park-Bench Positions

Radu,

Balaci,

Leucuța

et al. 2024

Medicina

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Background/Objectives: Patient positioning during surgery can influence intra- and postoperative complications. Therefore, we assessed the impact of the sitting and park-bench positions on anesthetic parameters and complications in neurosurgical patients. Methods and Patients: For this retrospective study, 314 adults who underwent neurosurgical procedures for posterior fossa pathologies were divided into two groups: sitting (n = 231) and park-bench (n = 83). The following data were collected, monitored, recorded, and compared: age, sex, tumor type, surgical approach, cardiovascular and respiratory complications, and postoperative surgical complications. The association of hypotension with the position was further investigated through multivariate logistic regression models by adjusting for CO2 decrease, desaturation, and documented gas embolism. Results: The average age was significantly lower in the sitting group (55 years, interquartile range (IQR) = 43–63; female proportion = 59.74%) than in the park-bench group (62 years, IQR = 45–74; female proportion = 57.83%) (p < 0.001). Cerebellopontine angle tumors were detected in 37.23% of the patients who underwent an operation in the sitting position and in 7.26% who underwent an operation in the park-bench position (p < 0.001). Patients in the sitting position had significantly greater anesthetic complication (91.77% vs. 71.08%, p < 0.001), hypotension (61.9% vs. 16.87%), and >2 mmHg CO2 decrease (35.06% vs. 15.66%, p < 0.001) incidences. Hypoxemia and death occurred more frequently in the park-bench group (8.43% vs. 1.73% and 6.03% vs. 1.3%, respectively). Conclusions: Compared with the park-bench position, the sitting position was associated with a greater specific anesthetic complication incidence and lower postoperative mortality rate, indicating a need for careful risk-benefit assessment when selecting each individual patient’s surgical position.

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Position-dependent hemodynamic changes in neurosurgery patients: A narrative review

Cited by 3 publications

References 89 publications

Cerebral Perfusion Unveiled: A Comprehensive Review of Blood Pressure Management in Neurosurgical and Endovascular Aneurysm Interventions

Cerebral Perfusion Unveiled: A Comprehensive Review of Blood Pressure Management in Neurosurgical and Endovascular Aneurysm Interventions

Cerebrovascular pulsatility indicates preoperative subcortical cognitive impairment and an increased risk for postoperative delirium in elderly patients undergoing elective spine surgery

Outcomes and Complications of Posterior Fossa Surgery in Sitting Versus Park-Bench Positions

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