In Defense of Desflurane: Is There a Specific Role for Desflurane in Neuroanesthesia? DOI Creative Commons

Shailendra Joshi,

Vidur Joshi

Journal of Neuroanaesthesiology and Critical Care, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 24, 2024

Abstract It is challenging to counter the widespread criticism of desflurane as volatile anesthetic agent with most significant greenhouse gas effect, one which likely exacerbate global warming. In 2022, journal “Anaesthesia” published guidelines for minimizing impact gases on warming, community has largely embraced. One its recommendations was removal from drug formularies. However, this review underlines benefits in context actual and potential neurological injuries. With an estimated 13.8 million neurosurgical operations performed annually, could offer advantages some these patients. Therefore, it imperative develop environmentally safe approach use rather than remove We discuss desflurane's environmental impact, unique chemical properties, specific application neuroanesthesia practice. Based existing evidence, we argue that hasten wake-up propose switching toward end surgery patients at risk of, or with, Predictable, early, monitorable cases prevent surgical delays, avoid additional investigations, enable early detection new deficits. Instead a blanket ban, should be investigated—systematically carefully. education, well-defined indications, limited use, intelligent vaporizers, scavenging, recycling systems, justified under circumstances. Moreover, problem damage inhaled anesthetics must comprehensively evaluated. Minimizing positive step protect environment, but anesthesiologists enforce other measures environment equal urgency.

Language: Английский

Reshaped functional connectivity gradients in acute ischemic stroke DOI Creative Commons
Cemal Koba, Joan Falcó-Roget, Alessandro Crimi

et al.

NeuroImage Clinical, Journal Year: 2025, Volume and Issue: 45, P. 103755 - 103755

Published: Jan. 1, 2025

Language: Английский

Citations

0
The Evolving Landscape of Radiomics in Gliomas: Insights into Diagnosis, Prognosis, and Research Trends DOI Open Access
Mehek Dedhia, Isabelle M. Germano

Cancers, Journal Year: 2025, Volume and Issue: 17(9), P. 1582 - 1582

Published: May 6, 2025

Gliomas are the most prevalent and aggressive form of primary brain tumors. The clinical challenge in managing patients with this disease revolves around difficulty diagnosis, both at onset during treatment, scarcity prognostic outcome indicators. Radiomics involves extraction quantitative features from medical images help artificial intelligence, positioning it as a promising tool to be integrated into care glioma patients. Using data 52 studies 12,482 over two years, review explores how radiomics can enhance initial diagnosis gliomas, especially helping differentiate treatment stages that may difficult for human eye do otherwise. has also been able identify patient-specific tumor molecular signatures targeted treatments without need invasive surgical biopsy. Such an approach could lead earlier interventions more precise individualized therapies tailored each patient. Additionally, practice improve longitudinal predict recurrence. Finally, potential outcomes, providers set realistic expectations. While field is continuously evolving, future research should conduct such larger, multi-institutional cohorts generalizability applicability focus on combining other modalities its predictive accuracy utility.

Language: Английский

Citations

0
Correlation of Edema/Tumor Index With Histopathological Outcomes According to the WHO Classification of Cranial Tumors DOI Open Access

Gervith Reyes Soto,

Daniel Alejandro Vega-Moreno,

Carlos Catillo-Rangel

et al.

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 3, 2024

Background: Metastatic brain tumors are a prevalent challenge in neurosurgery, with vasogenic edema being significant consequence of these lesions. Despite the critical role peritumoral prognosis and patient outcomes, few studies have quantified its diagnostic prognostic implications. This study aims to evaluate correlation between edema/tumor index (ETI) histopathological outcomes according 2021 WHO classification cranial tumors. Methodology: We conducted retrospective analysis Digital Imaging Communications Medicine (DICOM)-format magnetic resonance imaging (MRI) data from May 2023 2024, applying manual 3D volumetric segmentation using Image Tool Kit-SNAP (ITK-SNAP, version 3.8.0, University Pennsylvania) software. The ETI was calculated by dividing volume tumor volume. included 60 patients, statistical analyses were performed assess histopathology, including Receiver Operating Characteristic (ROC) curve for cutoff points. Results: A total patients study, 27 males (45%) 33 females (55%). average measured 46.9 cubic centimeters (cc) (standard deviation [SD] ± 25.6), 79 cc (SD 37.5) malignant each case. Malignant (WHO grades 3 4) had mean 1.6 1.2), while non-malignant 1 2) 1.2 1.1), but this difference not statistically (P = 0.51). ROC did provide reliable point predicting malignancy (area under [AUC] 0.59, P 0.20). larger observed tumors, correlate significantly grade. Conclusions: found no grade classification. While associated volumes both edema, prove be predictor malignancy. Therefore, should used as standalone metric determining aggressiveness or guiding clinical decision-making. Further cohorts required better understand potential value

Language: Английский

Citations

1
Reshaped functional connectivity gradients in acute ischemic stroke DOI Creative Commons
Cemal Koba, Joan Falcó-Roget, Alessandro Crimi

et al.

bioRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: April 25, 2024

ABSTRACT Ischemic brain stroke disrupts blood flow, leading to functional and structural changes associated with behavioral deficits. Importantly, despite this disruption occurring in localized regions, the resulting organization are both high-dimensional widespread across human cortex. However, mechanisms which these global patterns emerge subsequent deficits they entail, remain largely unexplored. Functional connectivity gradients provide consistent, reproducible, robust low-dimensional representations of function that can be explored reduce heterogeneity a handful axes along is organized. Here, we investigated how canonical gradient space by aligning each patient control-averaged embedding computing distances “correct” positions quantify deviations their contribution explicitly corrected for stroke-induced hemodynamic lags further study contribution. We found lag correction enhanced most prominently second gradient, on visual somatomotor concentrated. Additionally, identified significant primarily within somatomotor, visual, ventral attention networks, correlating impairments. studied hemispheric asymmetries finding intact hemispheres preserve comparable asymmetry while damaged ones presented important changes. Lastly, right-sided lesions displayed more than contralateral lesions. Overall, evidence 1) correcting improves accuracy, as indicated increased percentages explained variance, 2) impairments result from repositioning region-based profiles low-dimensional, interpretable space. This suggests large-scale alterations manifest slight, predictable movements confined visual-somatomotor axis.

Language: Английский

Citations

0
In Defense of Desflurane: Is There a Specific Role for Desflurane in Neuroanesthesia? DOI Creative Commons

Shailendra Joshi,

Vidur Joshi

Journal of Neuroanaesthesiology and Critical Care, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 24, 2024

Abstract It is challenging to counter the widespread criticism of desflurane as volatile anesthetic agent with most significant greenhouse gas effect, one which likely exacerbate global warming. In 2022, journal “Anaesthesia” published guidelines for minimizing impact gases on warming, community has largely embraced. One its recommendations was removal from drug formularies. However, this review underlines benefits in context actual and potential neurological injuries. With an estimated 13.8 million neurosurgical operations performed annually, could offer advantages some these patients. Therefore, it imperative develop environmentally safe approach use rather than remove We discuss desflurane's environmental impact, unique chemical properties, specific application neuroanesthesia practice. Based existing evidence, we argue that hasten wake-up propose switching toward end surgery patients at risk of, or with, Predictable, early, monitorable cases prevent surgical delays, avoid additional investigations, enable early detection new deficits. Instead a blanket ban, should be investigated—systematically carefully. education, well-defined indications, limited use, intelligent vaporizers, scavenging, recycling systems, justified under circumstances. Moreover, problem damage inhaled anesthetics must comprehensively evaluated. Minimizing positive step protect environment, but anesthesiologists enforce other measures environment equal urgency.

Language: Английский

Citations

0