Adequate cerebral perfusion pressure with quick and smooth emergence from anesthesia is a major concern of the neuroanesthesiologist. Anesthesia techniques that minimize anesthetic requirements and their effects may be beneficial. Esmolol, a short acting hyperselective β-adrenergic blocker is effective in blunting adrenergic response to several perioperative stimuli and so it might interfere in the effect of the anesthetic drugs on the brain. This study was designed to investigate the effect of esmolol on the consumption of propofol and sevoflurane in patients undergoing craniotomy. Forty-two patients that underwent craniotomy for aneurysm clipping or tumour dissection were randomly divided in two groups (four subgroups). Anesthesia was induced with propofol, fentanyl and a single dose of cis-atracurium, followed by continuous infusion of remifentanil and either propofol or sevoflurane. Patients in the esmolol group received 500 mcg/kg of esmolol bolus 10 min before induction of anesthesia, followed by additional 200 mcg/kg/min of esmolol. Monitoring of the depth of anesthesia was also performed using the Bispectral Index-BIS and cardiac output. The inspired concentration of sevoflurane and the infusion rate of propofol were adjusted in order to maintain a BIS value between 40–50. Intraoperative emergence was detected by the elevation of BIS value, HR or MAP. The initial and the intraoperative doses of propofol and sevoflurane were 18–50 mcg/kg/min and 0.2–0.5 MAC respectively in the esmolol group, whereas in the control group they where 100–150 mcg/kg/ and 0.9–2.0 MAC respectively (p = 0.000 for both groups). All procedures were anesthesiologically uneventful with no episodes of intraoperative emerge. Esmolol is effective not only in attenuating intraoperative hemodynamic changes related to sympathetic overdrive but also in minimizing significant propofol and sevoflurane requirements without compromising the hemodynamic status. ClinicalTrials.gov Identifier: NCT02455440 . Registered 26 May 2015.

Incorporation of radiology into anatomy education is a frequently used teaching strategy. Our purpose was to investigate to what extent virtual reality can play a significant role when radiology is taught in conjunction with anatomy. PubMed, SCOPUS, Education Resources Information Center, and Cochrane databases were searched for articles with the aim to evaluate the outcomes of incorporation of radiology in anatomy education, using virtual reality. From each included paper, the following data were extracted: authors, number of participants, type of study (comparative or not), level of outcome according to Kirkpatrick hierarchy, and outcomes of the use of virtual reality when radiology was incorporated in anatomy education. Seven papers were included. From them, three were comparative and evaluated students’ academic performance after the educational intervention, while four were non-comparative and evaluated only students’ opinions about the intervention. In all studies, the use of virtual reality for the incorporation of radiology into anatomy teaching was positively perceived. Also, the three studies which evaluated academic performance showed that virtual reality was effective in terms of enhancing anatomy knowledge. The implementation of virtual reality for the incorporation of radiology into anatomy education has been accompanied by positive outcomes. These outcomes may encourage educators to teach radiology in conjunction with anatomy using virtual reality.