Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients
Richardson, Palmeri, Williams et al. (JNS)
Retrospective review of 2657 consecutive cases and 1593 patients at Children’s Hospital Colorado from 2006 to 2012. After exclusion criteria (recent hemorrhage or high risk of hemorrhage), 1451 procedures comprised the study sample. Procedures were stratified into 5 different categories (Type 1: Intradural craniotomy/craniectomy except Chiari I malformation, Type 2: Intradural catheter/endoscope placement, Type 3: Extradural craniotomy/craniectomy + Chiari I malformation, Type 4: Spinal procedure, Type 5: Minor procedure (e.g., EVD, intracranial pressure monitor). Exposure was considered if the patients received 1 dose of ketorolac within 72 hours of their neurosurgical procedure. Outcomes measured were clinically significant hemorrhage, radiographic evidence of hemorrhage, or renal/GI complications related to ketorolac. Ketorolac was administered in 65.8% of cases. 2 patients developed GI tract ulceration and 2 patients developed renal failure. These events were not felt by the authors to be specifically related to the ketorlac. 7 patients developed clinically significant (requiring reoperation) hematomas. 4 of the patients received ketorolac perioperatively while 3 did not, suggesting no statistically significant difference. The authors claim that there is no association between ketorolac use and clinically or radiographically significant hemorrhage.
Abstract link: http://thejns.org/doi/full/10.3171/2015.4.PEDS14411
Vestibulo-ocular dysfunction in pediatric sports-related concussion
Ellis MJ, Cordingley D, Vis S, et al. (Journal of Neurosurgery: Pediatrics)
In this retrospective review of 101 pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS), the authors examined the association between vestibulo-ocular dysfunction (VOD) and the development of PCS. VOD was defined as more than one subjective vestibular and oculomotor complaint and more than one physical exam finding. Patients were considered fully recovered when asymptomatic at rest by interview and Post-Concussion Symptom Scale, able to return to school and sports without symptoms, and no longer met criteria for VOD. Patients with acute SRC and VOD had a significant increase in odds of developing PCS (adjusted OR 4.10) and a mean duration of symptoms of 40 days compared with 21 days in acute SRC patients without VOD.
Abstract link: http://www.ncbi.nlm.nih.gov/pubmed/26031619
The safety and efficacy of use of low-molecular-weight heparin in pediatric neurosurgical patients
David D. Gonda, MD, Jared Fridley, MD, Sheila L. Ryan, MPH, JD, et al. (Journal of Neurosurgery)
The conclusions reached in the article are stated too definitively. Although this study provides new insight to the use of LMWH with this patient population, it lacks the validity of a blinded randomized controlled study comparing the effects of LMWH with the current standard of care to make claims that LMWH is safe, effective, and recommended for routine use. While their findings are encouraging, the study is too limited to confidently change patient management. At best, they’ve shown similar outcomes to treatment with unfractionated heparin or oral anticoagulants, which may provoke further research on the topic.
Abstract link: http://thejns.org/doi/abs/10.3171/2015.1.PEDS14489?url_ver=Z39.88-