Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Background: Acute traumatic spinal cord injury (tSCI) represents a devastating condition with significant morbidity and mortality. Anesthetic management during emergency surgery may influence secondary injury cascades and subsequent neurological recovery through hemodynamic optimization, neuroprotective agent selection, and avoidance of physiological insults. However, the impact of specific anesthetic strategies on outcomes remains incompletely characterized.

Objective: This systematic review and meta-analysis evaluated the association between anesthetic management strategies and neurological and survival outcomes in patients undergoing emergency surgery for acute tSCI.

Methods: We systematically searched PubMed, Embase, and Cochrane Library databases from inception to January 2026 for studies comparing anesthetic approaches in adult patients undergoing emergency spinal decompression surgery following acute tSCI. Primary outcomes were neurological improvement measured by American Spinal Injury Association (ASIA) grade change and mortality. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models.

Results: Twenty-three observational studies and 2 randomized controlled trials encompassing 4,847 patients met inclusion criteria. Maintenance of mean arterial pressure (MAP) ≥85 mmHg was associated with improved neurological outcomes (OR 1.58, 95% CI 1.21–2.06; I²=62.3%). Hypotensive episodes (MAP <70 mmHg for >10 minutes) during the intraoperative period significantly increased mortality risk (OR 2.34, 95% CI 1.67–3.28; I²=48.9%). Propofol-based total intravenous anesthesia was associated with lower odds of poor neurological recovery compared to volatile anesthetic-based regimens (OR 0.71, 95% CI 0.54–0.93; I²=41.2%). The use of high-dose methylprednisolone demonstrated no significant benefit on neurological outcomes (OR 1.12, 95% CI 0.89–1.41; I²=54.7%) but was associated with increased pulmonary complications (OR 1.42, 95% CI 1.08–1.87).

Conclusion: Hemodynamic optimization targeting MAP ≥85 mmHg and avoidance of intraoperative hypotension are critical components of anesthetic management associated with improved outcomes in acute tSCI surgery. Anesthetic agent selection may influence neurological recovery, though evidence quality remains limited.

Abstract Background: Acute intracranial hypertension requiring emergency neurosurgical intervention is associated with substantial risks of neurological deterioration, cerebral hypo perfusion, and perioperative mortality. Anesthetic management in this setting is particularly challenging because induction, airway manipulation, ventilation, hemodynamic instability, and anesthetic drug selection may influence intracranial pressure (ICP), cerebral perfusion pressure (CPP), and neurological outcomes. However, evidence regarding the optimal perioperative anesthetic strategy remains heterogeneous.

Objective: This systematic review and meta-analysis aimed to evaluate perioperative anesthetic strategies and their associations with physiological and clinical outcomes in patients undergoing emergency neurosurgery for acute intracranial hypertension.

Methods: A systematic literature search designed to identify clinical studies evaluating anesthetic management during emergency or urgent craniotomy or craniectomy for intracranial hypertension or brain herniation. Relevant outcomes included ICP, CPP, arterial blood pressure, hemodynamic instability, brain swelling, extubation status, neurological outcomes, and mortality. Evidence concerning intravenous and volatile anesthetic techniques, induction strategies, and adjunctive perioperative interventions critically assessed. Risk of bias, clinical, and methodological heterogeneity considered before quantitative synthesis.

Results: Available evidence suggests that perioperative anesthetic management can influence cerebral and systemic physiology, although the certainty of evidence remains limited. Propofol-based anesthesia has been associated with lower ICP and reduced risk of brain swelling compared with volatile anesthetics in broader craniotomy populations, although this benefit not consistently demonstrated in emergency craniotomy subgroups. Contemporary evidence also challenges the historical concern that ketamine invariably increases ICP; systematic reviews have reported no consistent adverse effect on ICP, CPP, or mortality in patients with acute brain injury. Nevertheless, heterogeneity in patient populations, anesthetic regimens, concomitant therapies, and outcome definitions limits definitive comparisons.

Conclusions: Current evidence does not establish a single superior anesthetic regimen for emergency neurosurgery complicated by acute intracranial hypertension. Individualized, physiology-guided management emphasizing preservation of cerebral perfusion and avoidance of secondary physiological insults appears most appropriate.