The choice of anaesthesia for glioblastoma surgery does not impact the time to recurrence.

Anaesthetics used during cancer surgery may influence tumour cells and immunological response. The aim of this study was to evaluate a potential influence of the anaesthetic method (inhaled anaesthetics versus total-intravenous anaesthesia using propofol) on recurrence-free and overall survival in glioblastoma patients. We retrospectively identified patients undergoing resection of contrast enhancing glioblastoma under general anaesthesia followed by standard adjuvant treatment between January 2010 and February 2017 at two University Hospitals. Matched pairs of patients receiving either balanced with volatile anaesthetics or total intravenous anaesthesia were generated according to the known prognostic factors (extent of resection, methyl-guanine-methyl-transferase (MGMT) promoter methylation, age, Karnofsky performance score). Groups were compared using chi-square and Whitney-Man-U test. Time to recurrence was calculated using Kaplan Meier estimates. Log Rank test was used to assess the influence of the anaesthetic method. One hundred and fifty-eight (79:79) patients were included. Groups showed no significant difference in recurrence-free (volatiles: 8.0 (95% CI 6.5-9.8) vs. propofol: 8.4 (95% CI 7.9-10.1) months; p = 0.54) or overall survival (propofol: 17.4 (95% CI 14.0-20.7) vs. volatiles: 16.9 (95% CI 13.9-20.1) months; p = 0.85). In contrast to potential beneficial effects in some other solid tumours, the choice of anaesthetic method had no impact on survival in patients with glioblastoma in a well-defined cohort.

Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome.

OBJECTIVE: Outcome in vestibular schwannoma (VS) surgery has improved enormously over the last decades. Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome. METHODS: We examined 502 VS tumors in 483 patients (227 men and 256 women) between 2005 and 2016. According to our patient selection and treatment algorithm, 488 operations (97%) were performed in the semi-sitting position, and 14 (3%) were in the supine position. Auditory and facial functions were analyzed before and after surgery as were perioperative complications. RESULTS: There were 182 patients (36%) with small tumors (Hannover classification T1-T3A) and 320 (64%) large tumors (T3B or T4). Of the patients, 14% were neurofibromatosis type 2 cases. Complete tumor resection was achieved in 96.4%. Hearing preservation occurred in 44% of patients with small tumors and 23% of those with large tumors (Hannover classification), and correlated significantly with tumor size (P < 0.001). Facial palsy (House Brackmann grades II-VI) was present in 63 patients before and in 185 patients after surgery. Useful facial function (House Brackmann grades I-III) early after surgery was maintained in 86% of patients with small tumors and in 77% of patients with large tumors. Intraoperative complications included air embolism in 45 cases (9%), sinus injury in 3 cases, cerebrospinal fluid leakage in 46 cases (9%), and local hemorrhage in 19 cases (4%). Surgical revision was indicated in 31 cases (6%). CONCLUSIONS: In a standardized setting, the semi-sitting position allowed a safe approach. This setting offers the advantage of bimanual tumor nerve handling by the surgeon and an optimal visualization of important functional structures.

[The DGAI training module 2 in anaesthetic focussed sonography: vascular sonography]. / DGAI-zertifizierte Seminarreihe Anästhesie Fokussierte Sonografie - Modul 2: Gefäßsonografie.

Modul 2 will provide the theory and practical training of the sonographically guided puncture of central and peripheral veins and arteries. In doing so patients of all age groups are taken into consideration. Combined with the content of the other modules this series of workshops, which was initiated by our society, might be a first step in defining a new core competency of our specialty. The confident use of ultrasound in vascular puncture sharpens our dedicated professional competence and will contribute to continuously improve the quality and safety of anaesthesiologic patient care.

[Anesthesia in pediatric neurosurgery]. / Anästhesiologisches Management in der pädiatrischen Neurochirurgie.

Due to the complexity of neurosurgical and neuroradiologic interventions and diagnostic procedures in pediatric patients the anesthesiologist is particularly challenged. Anesthesiological management in neuropediatric interventions necessitates both profound knowledge of pediatric anesthesia and thorough understanding of neurological pathophysiology. This review describes in detail neuropediatric anesthesiology with an emphasis on airway management, intraoperative positioning, volume therapy and intraoperative monitoring.

[Paediatric anaesthesia for neurosurgical procedures]. / Spezielle pädiatrische Neuroanästhesie und Neurochirurgie.

Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis. Neurosurgical therapy of newborn children is related mostly to hereditary spinal dysraphism. In spinal surgery and specific intracranial procedures for monitoring reasons sensory and/or motor evoked potentials (SEP, MEP) are used to improve surgical outcome. Due to sensibility for anaesthetic drugs these techniques request sound knowledge of physiologic and pharmacologic interaction. Cerebrovascular malformations are today usually treated using radiologic interventional procedures. Operative access will be performed for selected cases additionally to embolization, but is associated with risk of massive bleeding. Severe traumatic craniocerebral injury leads to compromised cerebral blood flow and hypoxic ischemia. The article imparts funded knowledge of surgical as well as anaesthetic rationale and techniques in neuropaediatric therapies.

Sonographic imaging of the sciatic nerve and its division in the popliteal fossa in children.

BACKGROUND: High resolution ultrasound is a possible option for anesthetists to detect nerves. We tested the possibility of imaging the sciatic nerve and its division into the tibial and peroneal part using high resolution ultrasound in children. METHODS: Twelve children up to 45 kg body weight were randomly selected. Using a handheld ultrasound system with a 10 MHz linear array probe the popliteal fossa and the back of the thigh were examined and measured. The sciatic nerve and its division were depicted by ultrasound. RESULTS: The sciatic nerve and its division could be displayed in all children. The position of the nerve division showed large anatomical variation. CONCLUSIONS: Ultrasound opens a window to detect the anatomy of the sciatic nerve in children. In addition, the surrounding anatomical structures can also be depicted. The results suggest a possibility of safe placement of a cannula for blockade of the sciatic nerve under visual control.

Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe.

UNLABELLED: Standard transesophageal echocardiography (TEE) does not allow cardiac monitoring during the induction of anesthesia because standard probes would limit the oropharyngeal space and impair mask ventilation and tracheal intubation. We hypothesized that a prototype, miniaturized TEE probe could be safely introduced transnasally in awake patients and that mask ventilation and orotracheal intubation could be performed while continuously monitoring left ventricular (LV) function during the induction of anesthesia. Forty-five patients were studied prospectively. The transnasal TEE probe was introduced through one of the nares and advanced until a transverse plane image of the LV at the level of the papillary muscles was seen. Anesthesia was induced, and the patients were ventilated with a mask that had previously been threaded over the TEE probe via a central perforation. Probe insertion was successful in 12 patients under local anesthesia alone and in an additional 31 patients with a combination of local anesthesia and mild sedation. In two cases, probe placement was unsuccessful. Overall, hemodynamic variables did not change significantly during insertion. No case of significant mucosal bleeding was seen. In one patient, regurgitation of gastric contents occurred without affecting the perioperative outcome. The two-dimensional echocardiogram image quality of the LV during the induction of anesthesia was good or acceptable in 95% of patients. We conclude that transnasal TEE can effectively be used for cardiac monitoring during the induction of general anesthesia. IMPLICATIONS: This study demonstrates that it is feasible and generally safe to introduce a miniaturized transesophageal echocardiography probe transnasally in awake cardiac risk patients to monitor cardiac performance during the induction of general anesthesia.