Vestibular Schwannoma tumor withdrawal – case report

Vestibular Schwannomas (VS), benign intracranial tumors originating from the vestibulocochlear nerve, whose symptoms usually are hearing loss, tinnitus, and balance dysfunction. Rarely, however, if untreated, these neoplasms can cause significant patient compromise – resulting in facial paralysis, brainstem compression, and even death. Neurosurgical problems are the neuro-vascular structures often surrounding the tumors. The annual incidence of cystic vestibu-lar schwannomas in literature is 19.4%. A 66-year-old woman came to our clinic with serious hearing loss, balance dysfunction and tinnitus in the left ear. Full imaging diagnostic of the head was performed (TK, MRI and angio-MRI) which showed a cystic vestibular Schwannoma n. VIII (CVS). After 12 years of observation we noticed full neurological symptoms withdrawal and significant reduction of the tumor volume.Osłoniaki nerwu przedsionkowo-ślimakowego (n. VIII) to grupa łagodnych nowotworów, zwykle wyrastających z przewodu słuchowego wewnętrznego (PSW) i penetrujących wtórnie do okolicy kąta mostowo-móżdżkowego (KMM). Guzy rosną zazwyczaj powoli, jednak ze względu na otaczające je struktury nerwowo-naczyniowe stanowią duży problem operacyjny w neurochirurgii. W piśmiennictwie częstość występowania osłoniaka z torbielą wynosiła 19,4%. Najczęstszymi objawami są: utrata słuchu, szumy w uszach i zawroty głowy. Kobieta 66-letnia kobieta zgłosiła się z objawami znacznego niedosłuchu ucha lewego, odczuwaniem pisków i trzasków w uchu lewym, zaburzeniami równo-wagi. U chorej wykonano pełną diagnostykę obrazową w postaci tomografii komputerowej (TK) głowy i rezonansu magnetycznego (RM) głowy. Początko-wo wysunięto podejrzenie zmiany w okolicy lewego KMM o charakterze he-mangioblastomy. Angio-MR głowy nie potwierdziło rozpoznania. Wysunięto podejrzenie osłoniaka n. VIII z torbielą. Pacjentka była poddana 12-letniej obserwacji. W tym czasie doszło do całkowitego wycofania się objawów neurologicznych i znacznej regresji guza

Neurofibromatosis type II – case report

We present a case report of a 49-year-old female patient with type II neurofi-bromatosis (NF-2), recognized at the age of 34. NF-2 is one of the phakomatoses in which multiple neoplasms of the central nervous system (CNS) occur: neuromas (Schwannomas), meningiomas, ependymomas, pilocytic astrocytomas and other benign neoplasms. NF-2 is an incurable genetic disorder and the only way to treat patients is detailed diagnostic imaging, early recognition and removal CNS tumors. The most important aspect is to recognize and cure Schwannomas of the acoustic nerve in their early stages because it is the only way to prevent hearing loss and to help NF-2 patients to maintain a good quality of life. The main way to treat Schwannomas of the acoustic nerves is their surgical removal.W niniejszej pracy przedstawiono przypadek 49-letniej chorej z nerwiakowłók-niakowatością typu 2 (neurofibromatosis type II – NF-2), rozpoznaną w wieku 34 lat. Omówiono NF-2 jako jedną z fakomatoz, w której występują m.in. mno-gie zmiany nowotworowe ośrodkowego układu nerwowego (OUN), przede wszystkim osłoniaki, jak nerwiaki i schwannoma, ale również oponiaki, wyściół-czaki, glejaki włosowatokomórkowe i inne łagodne nowotwory OUN [1]. Jest to choroba genetycznie uwarunkowana, tym samym nieuleczalna [2], a jedynym sposobem postępowania z chorymi na NF-2 jest dokładna diagnostyka obrazowa, wczesne rozpoznawanie zmian guzowatych OUN i ich usuwanie [3]. Szczególnie ważne jest wczesne rozpoznawanie i leczenie osłoniaków nerwu słuchowego (n. VIII), gdyż tylko wówczas istnieje możliwość zachowania słuchu i w związku z tym zapewnienie komfortu życia chorym z NF-2. Operacyjne usuwanie osłoniaków n. VIII jest zasadniczym sposobem ich leczenia [1]

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged >= 18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARR(adj)). This study is registered with ClinicalTrials. gov, number NCT01865513.Findings Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7.6%] of 21 694); ORadj 1.86, 95% CI 1.53-2.26; ARR(adj) -4.4%, 95% CI -5.5 to -3.2). Only 2.3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1.31, 95% CI 1.15-1.49; ARR(adj) -2.6%, 95% CI -3.9 to -1.4) and the administration of reversal agents (1.23, 1.07-1.41; -1.9%, -3.2 to -0.7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1.03, 95% CI 0.85-1 center dot 25; ARR(adj) -0.3%, 95% CI -2.4 to 1.5) nor extubation at a train-of-four ratio of 0.9 or more (1.03, 0.82-1.31; -0.4%, -3.5 to 2.2) was associated with better pulmonary outcomes.Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications