Unplanned Post-Anesthesia Care Unit to ICU Transfer Following Cerebral Surgery: A Retrospective Study.

Background: Unplanned transfer to intensive care unit (ICU) lead to reduced trust of patients and their families in medical staff and challenge medical staff to allocate scarce ICU resources. This study aimed to explore the incidence and risk factors of unplanned transfer to ICU during emergence from general anesthesia after cerebral surgery, and to provide guidelines for preventing unplanned transfer from post-anesthesia care unit (PACU) to ICU following cerebral surgery. Methods: This was a retrospective case-control study and included patients with unplanned transfer from PACU to ICU following cerebral surgery between January 2016 and December 2020. The control group comprised patients matched (2:1) for age (±5 years), sex, and operation date (±48 hours) as those in the case group. Stata14.0 was used for statistical analysis, and p < .05 indicated statistical significance. Results: A total of 11,807 patients following cerebral surgery operations were cared in PACU during the study period. Of the 11,807 operations, 81 unscheduled ICU transfer occurred (0.686%). Finally, 76 patients were included in the case group, and 152 in the control group. The following factors were identified as independent risk factors for unplanned ICU admission after neurosurgery: low mean blood oxygen (OR = 1.57, 95%CI: 1.20-2.04), low mean albumin (OR = 1.14, 95%CI: 1.03-1.25), slow mean heart rate (OR = 1.04, 95%CI: 1.00-1.08), blood transfusion (OR = 2.78, 95%CI: 1.02-7.58), emergency surgery (OR = 3.08, 95%CI: 1.07-8.87), lung disease (OR = 2.64, 95%CI: 1.06-6.60), and high mean blood glucose (OR = 1.71, 95%CI: 1.21-2.41). Conclusion: We identified independent risk factors for unplanned transfer from PACU to ICU after cerebral surgery based on electronic medical records. Early identification of patients who may undergo unplanned ICU transfer after cerebral surgery is important to provide guidance for accurately implementing a patient's level of care.

Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections.

OBJECTIVE: Various implanted materials are used in neurosurgery; however, there remains a lack of pooled data on infection rates (IRs) and infective bacteria over past decades. The goal of this study was to investigate implant infections in neurosurgical procedures in a longitudinal retrospective study and to evaluate the IRs of neurosurgically implanted materials and the distribution of pathogenic microorganisms. METHODS: A systematic literature search was conducted using PubMed and Web of Science databases for the time period between 1968 and 2018. Neurosurgical implant infections were studied in 5 subgroups, including operations or diseases, implanted materials, bacteria, distribution by country, and time periods, which were obtained from the literature and statistically analyzed. In this meta-analysis, statistical heterogeneity across studies was tested by using p values and I2 values between studies of associated pathogens. Egger's test was used for assessing symmetries of funnel plots with Stata 11.0 software. Methodological quality was assessed to judge the risk of bias according to the Cochrane Handbook. RESULTS: A total of 22,971 patients from 227 articles satisfied the study's eligibility criteria. Of these, 1118 cases of infection were reported, and the overall IR was 4.87%. In this study, the neurosurgical procedures or disorders with the top 3 IRs included craniotomy (IR 6.58%), cranioplasty (IR 5.89%), and motor movement disorders (IR 5.43%). Among 13 implanted materials, the implants with the top 3 IRs included polypropylene-polyester, titanium, and polyetheretherketone (PEEK), which were 8.11%, 8.15%, and 7.31%, respectively. Furthermore, the main causative pathogen was Staphylococcus aureus and the countries with the top 3 IRs were Denmark (IR 11.90%), Korea (IR 10.98%), and Mexico (IR 9.26%). Except for the low IR from 1998 to 2007, the overall implant IR after neurosurgical procedures was on the rise. CONCLUSIONS: In this study, the main pathogen in neurosurgery was S. aureus, which can provide a certain reference for the clinic. In addition, the IRs of polypropylene-polyester, titanium, and PEEK were higher than other materials, which means that more attention should be paid to them. In short, the total IR was high in neurosurgical implants and should be taken seriously.

Effect of Mepilex on pressure sores in patients lying at lateral position after craniocerebral surgery / 现代临床护理

Objective To investigate the effect of Mepilex on pressure sores in patients at lateral position after craniocerebral surgery.Methods Toally 60 patients lying at lateral position after craniocerebral surgery were randomized into two groups in equal number with random digit table:the control group and experiment group.In the control group,Gel pad was used to prevent and treat the pressure sores and in the experiment group Mepilex was used between the compressed skin and operation table before setting the position.The skin conditions of the two groups were observed after operation.Result The prophylactic effect of pressure sore in the experiment group was significantly better than that in the control group (P＜0.05).Conclusion Mepilex can prevent the skin pressure sores in the patients at lateral position after cerebral surgery.

Pathological changes of the hippocampus and cognitive dysfunction following frontal lobe surgery in a rat model.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a known complication after intracranial surgery. Impaired hippocampal neurogenesis has been associated with cognitive dysfunction in animal models. METHODS: In order to assess hippocampal changes after brain surgery, a frontal lobe corticectomy was performed in ten adult Wistar rats (group 4). Three different control groups (n = 10 each) included no treatment (G1), general anesthesia alone (G2), and craniectomy without dural opening (G3). Twenty-four hours after surgery, half of the animals were killed, and the mRNA levels for IL-6, TNF-α, and brain-derived growth factor (BDNF) in the contralateral hippocampus were assessed by qPCR. Seven days later, the remaining animals underwent anxiety and memory testing. Afterwards, the number of immature neurons in the hippocampal cortex was measured by doublecortin (DCX) staining. RESULTS: Twenty-four hours after surgery, mRNA levels of IL-6 and TNF-α increased and BDNF decreased in both surgical groups G3 and G4 (p = 0.012). Cognitive tests demonstrated an increase in anxiety levels and memory impairment in surgical groups compared with non-surgical animals. These changes correlated with an inhibition of hippocampal neurogenesis evidenced by a decreased number of new neurons (mean ± SD for G1-4: 66.4 ± 24; 57.6 ± 22.2; 21.3 ± 3.78; 5.7 ± 1.05, p < 0.001, non-parametric ANOVA). CONCLUSIONS: Intracranial surgery was demonstrated to induce an inflammatory reaction within the hippocampus that compromised neurogenesis and impaired normal cognitive processing. Corticectomy had a greater effect than craniotomy alone, indicating a central trigger for hippocampal inflammatory changes. POCD after craniotomy may originate from a central inflammatory response resulting from surgical trauma to the brain parenchyma.

Application of clinical nursing pathway in early limbs activity of patients with high-risk hemiplegia in the department of cerebral surgery / 中国实用护理杂志

Objective To seek for the best clinical nursing pathway for early limbs activity of patients with high-risk hemiplegia in the department of cerebral surgery and to reduce limbs paralysis and improve their life quality.Methods Patients(112 cases)with high-risk bemiplegia in the department of cerebral surgery from January to December in 2007 were set as the experimental group.They took part in limbs early activity on the first day on admission with application of clinical nursing pathway.Patients(89 cases)of the same kind who took part in limbs activity from January to December in 2006 were set as the control group.The two groups were compared with Brunnstrom scale beth on admission and discharge.Results The Brunnstrom grade of upper limbs,hands and lower limbs of the experimental group was evidently higher than that of the control group(P＜0.05).Especially the isolated movement and coordination ability of the hands significantly increased(P＜0.01). Conclusions Early limbs activity with clinical nursing pathway for patients with high-risk hemiplegia in the department of cerebral surgery could reach the aim of recovery of limbs functional activity.

Infection with Pseudomonas aeruginosa after Brain Operation and Analysis of Drug Sensitivity / 中华医院感染学杂志

OBJECTIVE To study the infection of Pseudomonas aeruginosa after brain operation and drug-sensitivity.METHODS The system of BBLCrystalTM MIND-Crystal identification and Chinese software were used to identify P.aeruginosa.Drug-sensitivity was performed by K-B methods in accordance with NCCLS.RESULTS Totally 261 specimens were isolated from 126 patients during Mar to Dec 2005.From them 99 strains of P.aeruginosa were detected from specimens of 38 patients.There were 50 strains from phlegm,20 strains from suction in trachea,6 strains from urethral catheterization,8 strains from vein catheter,and 15 strains from wound excretion.Seventy seven strains(77.7%)were isolated during the peak period of May to August.Strains that were isolated in the same period possessed uniform drug-sensitivity results,which hinted epidemic of the same clone of P.aeruginosa in the Deparment of Cerebral Surgery.Drug-sensitivity results showed P.aeruginosa had been resistant to the common antibiotics.CONCLUSIONS Infection with P.aeruginosa after brain operation and drug resistance have already been serious,so we should think seriously of it.