Ajayan Neeraja, Hrishi Ajay Prasad, Rath Girija Prasad
National Institute for Neurology and Neurosurgery, University College of London NHS Hospital Trust, London, United Kingdom.
Sree Chitra Tirunal Institute for Medical Sciences, Thiruvananthapuram, Kerala.
Curr Opin Anaesthesiol. 2023 Oct 1;36(5):500-509. doi: 10.1097/ACO.0000000000001291. Epub 2023 Jul 6.
This article delves into recent advances in same-day neurosurgery (SDNS), specifically concerning indications, perioperative protocol, safety, and outcomes. Additionally, it explores the recent updates on awake craniotomy and awake spine surgery.
There is an evolving body of literature on studies about SDNS that reaffirm its safety and feasibility. awake craniotomy is associated with lesser neurological deficits and better survival benefits in patients with lesions in eloquent areas. Monitored anesthesia care, compared with the asleep-awake-asleep technique, is associated with lower failure rates, shorter procedure time, and shorter length of stay. However, the incidence of intraoperative seizures is lower with the asleep-awake-asleep technique. Propofol-based and dexmedetomidine-based anesthesia are similar with regard to procedure duration, intraoperative adverse events, and patient satisfaction; however, surgeon satisfaction is higher with dexmedetomidine-based anesthesia. In spine surgery, regional anesthesia when compared with general anesthesia, is associated with less intraoperative blood loss and a lower incidence of postoperative nausea and vomiting after 24 h. In addition, implementing an enhanced multimodal analgesia protocol improved disability scores and reduced the likelihood of postoperative complications.
SDNS offers promising prospects for patients and healthcare providers alike, with the potential to provide well tolerated, efficient, and cost-effective neurosurgical care in carefully selected cases.
本文深入探讨了当日神经外科手术（SDNS）的最新进展，特别是关于适应证、围手术期方案、安全性和结局。此外，还探讨了清醒开颅手术和清醒脊柱手术的最新进展。
关于SDNS的研究文献不断发展，重申了其安全性和可行性。对于功能区有病变的患者，清醒开颅手术导致的神经功能缺损较少，生存获益更好。与清醒-睡眠-清醒技术相比，监护麻醉护理的失败率更低、手术时间更短、住院时间更短。然而，清醒-睡眠-清醒技术的术中癫痫发作发生率更低。丙泊酚麻醉和右美托咪定麻醉在手术持续时间、术中不良事件和患者满意度方面相似；然而，右美托咪定麻醉的外科医生满意度更高。在脊柱手术中，与全身麻醉相比，区域麻醉导致的术中失血更少，术后24小时恶心呕吐的发生率更低。此外，实施强化多模式镇痛方案可改善功能障碍评分，降低术后并发症的可能性。
SDNS为患者和医疗服务提供者都带来了有前景的前景，有可能在精心挑选的病例中提供耐受性良好、高效且具有成本效益的神经外科护理。
