Aug 2026· Journal of modern medicine· Vol 14, pp. 595-603· 0 citations
Abstract
The choice of anesthetic strategy in children undergoing craniotomy for brain tumors requires a comprehensive assessment not only of intracranial hypertension control, but also of systemic hemodynamics, tissue perfusion, volemic status, and the profile of early postoperative complications. According to contemporary reviews, particular importance in pediatric neuroanesthesiology is attached to the safe maintenance of cerebral perfusion, reduction of the risk of postoperative nausea and vomiting, and the use of noninvasive markers of intracranial pressure, including ultrasonographic measurement of the optic nerve sheath diameter (ONSD).The aim of this review-analytical study was to compare the clinical and physiological effects of propofol and sevoflurane in children with brain tumors on the basis of a statistical analysis of 99 observations. The study included 51 patients in the propofol group and 48 patients in the sevoflurane group. The analysis demonstrated that propofol was associated with more stable mean arterial pressure after intubation and at the end of surgery, lower lactate levels by the completion of the procedure, and a lower incidence of early postoperative complications. At the same time, both anesthetic techniques provided a comparable reduction in ONSD by the end of surgery, indicating equally effective control of intracranial hypertension according to this noninvasive marker.The key clinical conclusions are as follows: baseline ONSD should not be regarded as the sole criterion for anesthetic selection; propofol offers advantages when greater hemodynamic stability, a more favorable metabolic profile, and prevention of postoperative nausea and somnolence are required; sevoflurane remains clinically relevant as an option with a tendency toward faster emergence. The scientific value of the study lies in the development of clinically oriented recommendations for the choice of anesthetic agent and infusion strategy in pediatric neurosurgery.
Awake craniotomy is a standard neurosurgical technique that enables real‐time assessment of brain functions during tumor resection, with high success rates. Although highly effective, the procedure is associated with hemodynamic disturbances, including blood pressure variability and impaired cerebral perfusion, compromising intraoperative safety. A focused literature search of PubMed, Embase, and Google Scholar was performed to identify relevant studies on intraoperative hemodynamic management during awake craniotomy. Findings were synthesized narratively to summarize current evidence, highlight emerging strategies, and identify knowledge gaps. Hypertension (8%–34%) was the most common disturbance, often triggered by painful surgical stimuli or emergence from sedation, with repeat craniotomy, impaired autoregulation, and glioma pathology as additional risk factors. Hypotension (10%–11%) was linked to perioperative stroke and mortality. Cerebral hypoperfusion contributed to poor outcomes, with stroke up to 23% and neurological morbidity in 68% of patients. Preventive strategies, such as scalp blocks, individualized blood pressure targets, and the use of dexmedetomidine and midazolam, improved intraoperative stability, while short‐acting agents, including esmolol and labetalol, were preferred for rapid control. Advanced monitoring modalities, including arterial lines, near‐infrared spectroscopy, and cerebral autoregulation indices, enhance safety and support accurate functional mapping. Hemodynamic instability during awake craniotomy influences outcomes. Current evidence supports multimodal prevention, tailored blood pressure control, and short‐acting pharmacological agents; practice variation and the lack of randomized trials limit standardization. Looking ahead, advanced monitoring and emerging AI systems may provide new opportunities to enhance cerebral protection and optimize patient safety. This review summarizes evidence on intraoperative hemodynamic control in awake craniotomy, emphasizing strategies that enable maximal safe resection while preserving neurological function.
Marc Knezevic Maragh, Alanna Pagan Garcia, Yuliia Oliinyk et al.· Anesthesiology Research and...· 0 citations
Carotid
endarterectomy
(CEAE) is the "gold standard" for stroke prevention in patients with hemodynamically significant carotid artery stenosis. The choice of anesthesia method — general (OA) or regional (RA) — remains a matter of debate, as it affects the risk of perioperative complications. This article analyzed 78 sources, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and meta-analyses published through 2026. There was no statistically significant difference in the incidence of perioperative stroke between OA and RA. However, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure. RA also correlated with shorter duration of surgery and hospitalization, but with more frequent hemodynamic fluctuations. The effectiveness of neuromonitoring (multimodal in OA and clinico-instrumental in RA) was a key factor determining neurological safety. Moderate hypothermia has shown potential in reducing
postoperative cognitive impairment. Thus, the choice between OA and RA in CEAE should be personalized, based on the patient's dominant risk profile.
A. Kazantsev· Transbaikalian Medical Bulle...· 0 citations
Background. Considerable attention is paid to the correction of ischemia and neuronal hypoxia within the set of therapeutic interventions, as this approach has demonstrated proven efficacy. The use of adequate and rational infusion therapy in patients with acute cerebrovascular accident (ACVA) enables the maintenance of optimal cerebral perfusion pressure, reduction of intracranial pressure, and correction of fluid and electrolyte balance. The purpose was to evaluate the correlations between inferior vena cava (IVC) diameter, clinical and laboratory parameters, and infusion therapy volume in patients with ischemic ACVA in order to optimize volemic support. Materials and methods. A retrospective multicenter study was conducted. Data from 30 patients with ACVA aged 69.6 ± 13.4 years were analyzed. All of them were treated in the intensive care unit and maintained spontaneous breathing without tracheal intubation. Ultrasound examination of IVC was performed in all patients. Exclusion criteria were cardiac tamponade, isolated right ventricular failure, elevated intra-abdominal pressure, mechanical ventilation, and obesity. IVC diameter was measured at end-expiration, 0.5–3.0 cm proximal to the junction with the right atrium, using a subcostal approach. Results. The results obtained demonstrated that IVC diameter was significantly associated with a number of clinical and laboratory parameters characterizing volemic status of patients with ACVA. An inverse relationship was found between IVC diameter and hemoglobin and hematocrit levels, indicating that smaller IVC diameter was associated with hemoconcentration. These findings confirm that IVC may be considered not only an ultrasonographic marker of preload, but also an integrated indicator of intravascular volume reflecting the biological manifestations of fluid deficiency. The ROC analysis additionally supported this hypothesis: IVC diameter demonstrated moderate ability to detect hemoconcentration (AUC = 0.76). This finding suggests the potential utility of IVC assessment as a noninvasive tool for evaluating volemic status in clinical practice. At the same time, the absence of a diagnostic value of IVC diameter in terms of fluid balance (AUC = 0.19) highlights the fundamental difference between biological and integral indicators. Fluid balance is influenced by multiple factors, including infusion therapy volume, diuresis, and physician-related clinical decisions, which limits its use as an independent marker of volemia. The observed association between IVC diameter and body temperature may reflect the role of systemic inflammatory response in the formation of volemic status. Increased body temperature likely contributes to greater fluid loss, indirectly resulting in reduced IVC diameter. However, this mechanism requires further investigation and should currently be regarded as hypothetical. A direct correlation between IVC diameter and daily diuresis suggests a possible association with renal perfusion, whereby greater intravascular volume is associated with higher urine output. The obtained findings also emphasize an important clinical implication: IVC diameter reflects the current volemic status but does not allow assessment of responsiveness to infusion therapy. Dynamic assessment methods are required for this purpose. Conclusions. To optimize volemic support in patients with ischemic stroke, IVC diameter should be evaluated as part of a multimodal approach that includes laboratory parameters (hemoglobin, hematocrit), clinical indicators (body temperature, diuresis), and, whenever possible, dynamic tests or invasive monitoring.
I. Nevmerzhytskyi, Yu.I. Markov· Emergency medicine· 0 citations
Background of the Study: Spinal anesthesia is one of the most commonly employed regional anesthetic techniques for elective surgical procedures involving the lower abdomen, pelvis, perineum, and lower extremities. It offers several advantages, including rapid onset, profound sensory and motor blockade, reduced postoperative pain, decreased blood loss, and avoidance of airway manipulation. Despite its widespread acceptance and safety profile, spinal anesthesia is associated with various complications ranging from mild adverse events such as hypotension, bradycardia, nausea, vomiting, and post-dural puncture headache to severe neurological and cardiovascular complications. Early recognition and management of these complications are essential to ensure patient safety and improve perioperative outcomes (Miller et al., 2020; Butterworth et al., 2022).Introduction: Spinal anesthesia involves the administration of local anesthetic agents into the subarachnoid space, producing reversible blockade of nerve conduction. Although considered a safe and effective anesthetic technique, complications may occur due to physiological changes, patient-related factors, drug effects, or technical errors. The incidence and severity of complications vary according to patient characteristics, surgical procedures, anesthetic techniques, and perioperative management. Continuous evaluation of these complications is necessary to improve anesthetic practice and develop preventive strategies (Gupta et al., 2017; Sharma & Gupta, 2020).Aim of the Study: To prospectively evaluate the incidence, pattern, and management of complications occurring during spinal anesthesia in patients undergoing elective general surgical procedures.Objectives of the StudyPrimary ObjectivesTo determine the incidence of complications associated with spinal anesthesia.To assess the frequency of hemodynamic complications such as hypotension and bradycardia.To evaluate neurological and other perioperative adverse events occurring during spinal anesthesia.Secondary ObjectivesTo identify patient-related and procedure-related risk factors associated with complications.To evaluate the management and outcomes of observed complications.To suggest preventive measures for improving patient safety during spinal anesthesia.Methodology: A prospective observational study was conducted in the Department of Anaesthesiology of a tertiary care teaching hospital. A total of 100 adult patients aged 18–60 years, belonging to ASA Physical Status I and II and scheduled for elective general surgical procedures under spinal anesthesia, were included in the study. Patients with coagulation disorders, neurological diseases, severe cardiac illness, infection at the puncture site, or contraindications to spinal anesthesia were excluded. Preoperative evaluation was performed for all patients. Standard monitoring including heart rate, blood pressure, oxygen saturation, and electrocardiography was instituted. Spinal anesthesia was administered under aseptic precautions using hyperbaric bupivacaine. Patients were observed intraoperatively and postoperatively for the occurrence of complications including hypotension, bradycardia, nausea, vomiting, shivering, post-dural puncture headache, urinary retention, failed block, high spinal block, and neurological deficits. Data were analyzed using IBM SPSS Version 26.0. Descriptive statistics, Chi-square test, and appropriate inferential statistical methods were used. A p-value <0.05 was considered statistically significant.Results: The study revealed that hypotension was the most common complication, observed in 32% of patients, followed by bradycardia (18%), nausea and vomiting (15%), shivering (12%), post-dural puncture headache (8%), urinary retention (5%), and failed spinal block (4%). Severe complications such as high spinal block and neurological deficits were rare, occurring in less than 1% of cases. Hemodynamic complications were significantly associated with increasing age, higher sensory block level, and prolonged surgical duration (p < 0.05). Most complications were successfully managed with standard therapeutic interventions, and no permanent morbidity or mortality was reported.Discussion: The findings of the present study demonstrate that spinal anesthesia remains a safe and effective anesthetic technique for elective general surgical procedures. The predominance of hypotension and bradycardia observed in this study is consistent with previous reports by Heesen et al. (2019), Kinsella et al. (2018), and Ahmed et al. (2019), who identified sympathetic blockade as the principal mechanism responsible for cardiovascular instability during spinal anesthesia.The incidence of post-dural puncture headache and neurological complications remained low, reflecting improvements in anesthetic techniques, use of smaller gauge spinal needles, and adherence to established clinical guidelines. The study further highlights the importance of vigilant monitoring and prompt management to minimize adverse outcomes.Conclusion: Spinal anesthesia is a reliable and effective anesthetic modality for elective general surgical procedures with a favorable safety profile. Although complications such as hypotension, bradycardia, nausea, vomiting, and post-dural puncture headache occur with varying frequency, most are transient and manageable with timely intervention. Proper patient selection, meticulous anesthetic technique, continuous monitoring, and early treatment of complications significantly contribute to improved perioperative safety and successful surgical outcomes.Summary: The prospective study evaluated complications associated with spinal anesthesia in elective general surgical procedures. Hemodynamic complications, particularly hypotension and bradycardia, were the most frequently encountered adverse events. Most complications were mild to moderate in severity and responded well to standard management. The study emphasizes the importance of preventive strategies, careful monitoring, and evidence-based anesthetic practice to enhance patient safety during spinal anesthesia.
Dr.Mahendra Kumar Verma, Mr. Atul Kumar, Mr. Dheeraj Berma et al.· PAIN, JOINTS, SPINE· 0 citations
Inhalational anesthetics are widely used in congenital cardiac surgery; however, anesthesia-related complications may affect intraoperative hemodynamic stability and surgical outcomes. This study evaluated the association between inhalational anesthesia-related complications and intraoperative hemodynamic parameters in patients undergoing surgery for congenital heart diseases (CHDs). A descriptive multicenter study was conducted between December 2025 and May 2026 at I.R.C.C.S. Policlinico San Donato Milanese (Italy), Tripoli Medical Hospital (Libya), and the Turkish Medical Team at Fallujah Hospital (Iraq). Patients undergoing congenital cardiac surgery under inhalational anesthesia were included. Data on CHD classification and intraoperative hemodynamic parameters were collected. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at 10, 20, 30, 40, 50, and 60 minutes during surgery. Statistical analysis was performed using SPSS version 21, with descriptive statistics and ANOVA used to assess differences according to anesthesia-related complications. A total of 23 patients were included. Cyanotic septal defects were the most common CHD category (61.7%), followed by cyanotic complex defects (23.4%). Significant differences in SBP were observed at 50 minutes (p=0.038) and 60 minutes (p=0.032), while DBP showed significant differences at both time points (p=0.01). Heart rate differed significantly at 20 minutes (p=0.048) and demonstrated a highly significant difference at 30 minutes (p=0.0001), particularly among patients who developed arrhythmias. These findings indicate that inhalational anesthesia-related complications are associated with significant intraoperative hemodynamic changes, with arrhythmias exerting the greatest impact on cardiovascular stability. Continuous cardiovascular monitoring remains essential during congenital cardiac surgery to optimize patient safety and perioperative outcomes.
Ghada Alnaeli, Sara Hwisa· AlQalam journal of medical a...· 0 citations
Both propofol and volatile inhalational agents have similar effects on brain relaxation during surgery, but propofol has slight benefits for ICP control, haemodynamic stability and for PONV, and desflurane has the best recovery times of the volatile agents across the current evidence network.
Sandeep M B, Swaroop Gejji· Journal of advanced scientif...· 0 citations