Introduction Sitting craniotomies are performed for surgical access to the posterior fossa. This position is advantageous for several reasons. Surgically, the positioning allows for improved access to deep structures within the posterior fossa. The positioning of the head relative to the heart in the sitting position allows for decreased intracranial pressure (ICP) and … [Read more...] about Medically Challenging Case: Management of a Venous Air Embolism in a Sitting Craniotomy
Educational Corner
EEG Signature(s): Anesthetic Titration
Introduction Whether electroencephalography (EEG) can lead to lower rates of postoperative neurocognitive disorders is still a topic of debate (1, 2). However, there are very strong indications for processed EEG (pEEG), which were addressed by the APSF in a 2022 publication (3). The APSF suggests that patients who are receiving less than 0.7 MAC of inhaled anesthetic or … [Read more...] about EEG Signature(s): Anesthetic Titration
Medically Challenging Case: Serotonin Syndrome During Vestibular Schwannoma Resection
Introduction Serotonin syndrome (SS) is a life-threatening medication reaction that poses significant diagnostic challenges in the perioperative setting. In SS, serotonergic compounds directly or indirectly over-activate serotonin receptors, leading to muscle rigidity, acidosis, autonomic derangement, and respiratory compromise (1). Review of the literature reveals case … [Read more...] about Medically Challenging Case: Serotonin Syndrome During Vestibular Schwannoma Resection
EEG Signature(s): Comparing Traditional Frontal Electrode Placement with Infraorbital (Malar) Placement for “Depth of Anesthesia” Monitoring Using the Masimo SedLine Monitor
Abbreviations: Depth of anesthesia (DOA) PSI- Patient safety index, Bispectral Index (BIS) , Density spectral array (DSA), electromyography (EMG), SEFL – Spectral edge frequency on the Left , SEFR – Spectral edge frequency on the Right, Suppression ratio (SR) Introduction Optimal “depth of anesthesia” (DOA) is crucial to ensure patient safety and improve surgical … [Read more...] about EEG Signature(s): Comparing Traditional Frontal Electrode Placement with Infraorbital (Malar) Placement for “Depth of Anesthesia” Monitoring Using the Masimo SedLine Monitor
Challenging Case: Perioperative Management of an LVAD-Dependent Patient with Acromegaly Undergoing Pituitary Adenoma Resection
Introduction Left Ventricular Assist Devices (LVADs) were initially developed as bridge therapy until transplantation but are now increasingly used as destination therapy for patients who are unable to undergo transplantation (1-4). As the number of patients receiving LVADs for destination therapy rises, general anesthesiologists are likely to encounter these complex cases … [Read more...] about Challenging Case: Perioperative Management of an LVAD-Dependent Patient with Acromegaly Undergoing Pituitary Adenoma Resection