Chaudhary Fihr, Ahmed Zubair, Agrawal Devendra K
Department of Translational Research, College of the Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California USA.
J Surg Res (Houst). 2024;7(2):250-266. Epub 2024 Jun 6.
Damage to the peripheral and central nervous systems is frequently irreversible. Surgically induced neurological damage and anesthesia may result in catastrophic situations for patients and their families. The incidence of significant neurological complications during the perioperative period is examined in this article. In contrast to other organs like the kidney, heart, liver, lungs, and skeletal system, native neurological function cannot be replaced with artificial parts or devices soon. Ignoring brain function during the perioperative period has been a systemic problem in anesthesiology, even though the central and peripheral nervous systems are crucial. This bold claim is intended to draw attention to the fact that, unlike the circulatory and respiratory systems, which have been routinely monitored for decades, the brain and other neural structures do not have a standard monitoring during surgery and anesthesia. Given that the brain and spinal cord are the principal therapeutic targets of analgesics and anesthetics, this deficiency in clinical care is even more alarming. Organs that are notoriously hard to repair or replace after damage have, up until now, received comparatively little attention. In this article, a succinct overview of five neurological complications associated with surgery and anesthesia is presented. After critically reviewing the literature on the subject, the article is focused to common (delirium), controversial (postoperative cognitive decline), and potentially catastrophic (stroke, spinal cord ischemia, or postoperative visual loss) adverse events in the neurological surgery setting. The findings will increase awareness of major neurological complications to the involved surgical and anesthesia team and enhance preventive and treatment strategies during the perioperative period.
外周和中枢神经系统的损伤往往是不可逆的。手术引起的神经损伤和麻醉可能给患者及其家属带来灾难性后果。本文探讨了围手术期严重神经并发症的发生率。与肾脏、心脏、肝脏、肺和骨骼系统等其他器官不同,天然的神经功能无法很快被人工部件或装置替代。尽管中枢和外周神经系统至关重要,但在围手术期忽视脑功能一直是麻醉学中的一个系统性问题。这一大胆论断旨在引起人们对以下事实的关注:与已经被常规监测数十年的循环和呼吸系统不同,大脑和其他神经结构在手术和麻醉期间没有标准的监测。鉴于大脑和脊髓是镇痛药和麻醉药的主要治疗靶点,临床护理中的这一缺陷更加令人担忧。那些受损后 notoriously hard to repair or replace(此处疑有误,可能是“极其难以修复或替换”)的器官,到目前为止受到的关注相对较少。本文简要概述了与手术和麻醉相关的五种神经并发症。在对该主题的文献进行严格审查后,本文重点关注神经外科手术环境中常见的(谵妄)、有争议的(术后认知功能下降)以及潜在灾难性的(中风、脊髓缺血或术后视力丧失)不良事件。这些发现将提高参与手术和麻醉团队对主要神经并发症的认识,并加强围手术期的预防和治疗策略。