Incorporating Perioperative Neuroscience
As the official journal of SNACC, the Journal of Neurosurgical Anesthesiology (JNA) has a long history of publishing original and review articles relevant to the SNACC membership. Prof. Martin Smith is the Editor-in-Chief. Subscribe to the JNA e-Table of Contents here and follow JNA on X (@JNeurosurgAnes). Online access to the JNA is a benefit of SNACC membership.
We are excited to share a preview of the upcoming January 2025 issue of the JNA as well as welcoming the new Editor-in-Chief, Dr Alana Flexman. We also present a new Fellow-led initiative, the Fellows Journal Club. Each issue of the JNA is accompanied by a podcast and a joint ICPNT-JNA journal club.
New Editor-in-Chief
Many congratulations to Dr Alana Flexman who has been appointed the new Editor-in-Chief of the JNA, commencing January 1, 2025. Dr Flexman is a Past President of SNACC and brings her expertise in perioperative brain health and quality improvement in perioperative neuroscience to the journal.
A huge thank you to Prof. Martin Smith for his expertise and leadership of the JNA over the last 7 years. The journal incorporates all aspects of perioperative neuroscience, from clinical practice to basic science research and is continuously evolving to meet the needs of clinicians, scientists and patients.
Highlights from JNA January 2025 issue
Focused review – Antiplatelet agents in endovascular neurointerventional procedures. Flesher, K et al. [in press]
This Focused Review provides an overview and update on periprocedural use of antiplatelet agents during endovascular neurointerventional procedures including pharmacology and current clinical practice. The authors note that many questions remain, and further research is warranted into the use of these agents.
Review Article: Enhanced Recovery After Surgery for Craniotomies: A Systematic Review and Meta-analysis. Kim, SH et al. doi: 10.1097/ANA.0000000000000967
This systematic review and meta-analysis included five randomised controlled trials, with 871 patients, to compare the effects of ERAS protocols and conventional perioperative care on postoperative outcomes during craniotomy. The primary outcome was post-operative length of stay. The authors found that ERAS protocols may be superior however further research is warranted, particularly on quality of recovery.
Clinical Investigation: Prospective Randomized Controlled Trial Comparing Anesthetic Management with Remimazolam Besylate and Flumazenil Versus Propofol During Awake Craniotomy Following an Asleep-awake-asleep Method. Sato, T. et al. doi: 10.1097/ANA.0000000000000975
This randomized controlled trial compared the use of remimazolam-based compared to propofol-based sedation awake craniotomy during the asleep-awake-asleep technique. 52 participants were recruited and the investigators found that remimazolam was associated with faster loss of consciousness and arousal after sedation.
This clinical investigation is accompanied by an Editorial: Time to Wake Up to Remimazolam’s Potential. Allen M et al. discuss the benefits and drawbacks of remimazolam as well as the importance of evaluation newly available drugs and their importance in contemporary anesthetic practice.
SNACC 2024 Annual Meeting Abstracts
Presented abstracts from the SNACC 2024 Annual Meeting will be published in the January 2025 JNA issue. Over 90 abstracts were presented by investigators from around the world, covering all topics from clinical perioperative practice to basic science research.
Eighth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium supplement
The January issue of JNA includes a supplement of the Eighth Pediatric Anesthesia and Neuro-Development Assessment (PANDA) Symposium held on March 9-10, 2024. The theme of the 2024 PANDA Symposium was “Anesthesia/Analgesia/Sedation and Brain Health in Children.” The Supplement includes 15 articles on diverse topics related not only to anesthetic neurotoxicity but also to the broader issue of brain health in children who are vulnerable to the adverse effects of the use of anesthetic and sedative agents. The supplement is edited by Dr Lena Sun from the Department of Anesthesiology and Pediatrics, Columbia University Medical Center, New York, and includes contributions from an international group of experts in this field.
Neuroanesthesiology Fellows Journal Club
Highlighted articles from the JNA 2024 editions
It can be a challenge to select one paper for presentation at a Journal Club, especially with such a plethora of high calibre articles in the JNA. Here are a few suggestions from the past year which will hopefully encourage interesting discussions as well as provide educational resources for trainees and Fellows.
Factors Associated with Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. Choi S. et al. doi: 10.1097/ANA.0000000000000867
This prospective observational study from the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, not only highlights the importance of care when positioning the prone patient but also risk factors for pressure injury. It explores Hospital Acquired Pressure Injury (HAPI) and investigates possible contributory factors to this including duration of prone positioning and intraoperative acidosis. It raises some excellent discussion points surrounding prone positioning and is relevant to everyday neuroanaesthesia practice. The importance of positioning concerns for spinal surgery are highlighted in Week 3 of the SNACC Neuroanesthesia Classroom as well as being a key learning objective under Goal 1 – Patient Care, in the Advanced Neuroanesthesiology Rotation.
Modified Thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial. Kumar A et al. doi: 10.1097/ANA.0000000000000900
This randomized controlled trial conducted at the All India Institute of Medical Sciences, Patna, includes 60 patients undergoing elective spinal surgery. Patients were randomly allocated to receive a GA plus modified TLIP (thoracolumbar interfascial plane) block or erector spinae plane (ESP) block as part of a multimodal analgesic regimen. Intra- and post-operative fentanyl consumption as well as post-operative pain scores were recorded and compared between groups. This trial raises several discussion points surrounding analgesic options for elective spinal surgery and the use of regional anaesthesia in this group of patients. It also lends itself to further education on the delivery of these regional blocks. Pain management strategies in spinal surgery are discussed in Week 3 of the SNACC Neuroanesthesia Classroom and highlighted as a key learning objective in the Advanced Neuroanesthesiology Rotation under Goal 2 – Medical Knowledge.
A Survey on Monitoring and Management of Cerebral Vasospasm and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Mantra Study. Picetti E et al. doi: 10.1097/ANA.0000000000000923
This international clinical practice survey endorsed by the European Society of Intensive Care Medicine and Neurocritical Care Society highlights the multiple ways to monitor and manage delayed cerebral ischaemia (DCI) due to vasospasm after acute subarachnoid haemorrhage (aSAH). The study, which includes 38 countries, discusses monitoring techniques used to elucidate delayed neurological deficits (DNDs). This includes neurological examination, transcranial Doppler and intracranial pressure (ICP) monitoring to name but a few. It also discusses the use of computed tomography angiography (CTA) to confirm cerebral vasospasm as the primary causative factor for these deficits associated with DCI. It goes further to investigate prevention strategies including the use of nimodipine and how the various centres involved manage cases of vasospasm in their units. The study provides a platform to spark discussions surrounding the detection and management of vasospasm and DCI. It allows trainees and Fellows to consider the methods used in their own departments and how these compare to other centres. This links to Week 1 of the SNACC Neuroanesthesia Classroom, topics surrounding cerebral anatomy and physiology. Themes from this survey are also highlighted in the SNACC Advanced Neuroanesthesiology learning objectives under Goal 2 – Medical Knowledge, where modes of neuroanaesthetic monitoring are discussed in more depth.
5-Aminolevulonic Acid, a New Tumor Contrast Agent: Anesthesia Considerations in Patients Undergoing Craniotomy. Schusteff et al. doi:10.1097/ANA.0000000000000941
This review article considers the use of 5-aminolevulonic acid (ALA) to guide resection of malignant gliomas. More specifically it highlights to the anaesthetist the possible risk profile of this drug and the potential problems that may be encountered in the perioperative period with its use. It investigates how drug dosage and administration regimes may affect its side effect profile. The study raises several interesting discussion points for trainees and Fellows including the balance between improved surgical tumour resection vs. drug side effect profile and how to manage the running of theatre lists where there may be small margins for essential pre-operative drug delivery. It reflects an ever evolving and innovative speciality. Theatre list management is discussed in more depth in the Advanced Neuroanesthesiology learning objectives under Goal 3 – Systems-Based Practice, where adaptability and flexibility in surgical scheduling are highlighted.
The next issue of the JNA will be published online in December 2024.
