Anaesthesia Considerations on Paediatric Neurosurgery - Turkish Journal of Anaesthesiology and Reanimation

Background: The increasing incidence of cerebrovascular accidents represents an emerging problem. The rise in risk factors such as lifestyle choices—smoking, poor nutrition, and metabolic diseases—poses a significant challenge for the global healthcare system. The female population, due to physiological conditions and iatrogenic risks, may be at a greater risk of developing ischemic accidents. In addition to these acquired conditions, life phases such as pregnancy or puerperium, and medical conditions like surgical treatments and hormone therapy, may elevate this risk. Methods: This narrative aims to assess the various risk factors specific to the female population and evaluate the appropriate management strategies, including anesthetic support. Anesthesia plays a crucial role in enabling pharmacological procedures, such as thrombolysis, or surgical procedures like thrombectomy, in the management of ischemic cerebrovascular events. Results: The review emphasizes the importance of early recognition of risk factors to ensure prompt diagnosis and the most appropriate treatment options for ischemic events. Anesthesia support has become essential for carrying out necessary medical interventions effectively. Choosing the right anesthesia technique for endovascular thrombectomy is particularly significant, requiring consideration of the patient’s characteristics, the timing of diagnosis, and the preferences of the interventional neuroradiologists. Conclusions: It is vital to identify risk factors in the female population early to facilitate timely diagnosis and optimize treatment outcomes. Anesthetic support plays a key role in ensuring that critical procedures, such as thrombolysis and thrombectomy, are carried out effectively. Tailoring anesthesia choices to the patient’s individual needs is critical for a successful intervention.

Background: Off-pump coronary artery bypass grafting (OPCAB) avoids cardiopulmonary bypass (CPB) and may reduce selected perioperative complications, but its technical and hemodynamic demands remain important limitations. Methods: We narratively reviewed the literature indexed in PubMed/MEDLINE and Scopus, supplemented by Google Scholar and reference-list screening, covering January 2000 to August 2026. Priority was given to systematic reviews, meta-analyses, randomized trials, prospective studies, guidelines, and relevant landmark reports. Results: OPCAB may be particularly useful in selected patients at increased risk from CPB or aortic manipulation. Cardiac displacement and coronary stabilization can cause rapid changes in preload, ventricular function, myocardial perfusion, and cardiac output, making invasive monitoring, transesophageal echocardiography, and coordinated hemodynamic management central to anesthetic care. Current evidence does not establish the superiority of volatile anesthesia or total intravenous anesthesia. Comparative studies suggest potential reductions in perioperative stroke, transfusion, renal complications, and hospital stay, although potential stroke benefits depend on the aortic-handling strategy and should not be attributed to avoidance of CPB alone. Concerns remain regarding completeness of revascularization, graft durability, repeat revascularization, and long-term survival. Conclusions: OPCAB should be considered an individualized strategy rather than a universal alternative to on-pump CABG. Optimal outcomes depend on patient selection, surgical expertise, vigilant monitoring, and timely correction of hemodynamic compromise. Potential neurological benefits should be interpreted in relation to the aortic-handling strategy, particularly when an anaortic/no-touch technique is used.

Background: Off-pump coronary artery bypass grafting (OPCAB) avoids cardiopulmonary bypass (CPB) and may reduce selected perioperative complications, but its technical and hemodynamic demands remain important limitations. Methods: We narratively reviewed literature indexed in PubMed/MEDLINE and Scopus, supplemented by Google Scholar and reference-list screening, covering January 2000 to September 2025. Priority was given to systematic reviews, meta-analyses, randomized trials, prospective studies, guidelines, and relevant landmark reports. Results: OPCAB may be particularly useful in selected patients at increased risk from CPB or aortic manipulation. Cardiac displacement and coronary stabilization can cause rapid changes in preload, ventricular function, myocardial perfusion, and cardiac output, making invasive monitoring, transesophageal echocardiography, and coordinated hemodynamic management central to anesthetic care. Current evidence does not establish superiority of volatile anesthesia or total intravenous anesthesia. Comparative studies suggest potential reductions in perioperative stroke, transfusion, renal complications, and hospital stay, but concerns remain regarding completeness of revascularization, graft durability, repeat revascularization, and long-term survival. Conclusions: OPCAB should be considered an individualized strategy rather than a universal alternative to on-pump CABG. Optimal outcomes depend on patient selection, surgical expertise, vigilant monitoring, and timely correction of hemodynamic compromise.