The History of Neurosurgical Management of Ischemic Stroke

Stroke remains a major public health issue and the second leading cause of death worldwide. The Hippocratic Corpus used the word apoplexy to describe a person collapsing while retaining pulse and respiration. This is believed to be the first written description of stroke. The theories of what caused stroke evolved over the years. When autopsies were performed stroke was attributed to emboli and thrombi formation. Carotid endarterectomies (CEA) were then performed for the treatment of stroke. Originally CEA were seen with skepticism but the North American Symptomatic Carotid Endarterectomy trial (NASCET) and the European Carotid Surgery trial (ECS) helped restore their efficacy in the management of ischemic stroke. A milestone in the management of ischemic stroke was the use of intravenous tissue plasminogen activator (tPA). Secondary to the limitations of the use of tPA other avenues were sought which included intraarterial recombinant prourokinase and mechanical thrombectomy. The field of mechanical thrombectomy continues to be rapidly changing and evolving. Various randomized controlled trials and meta-analysis have been conducted in order to evaluate who will benefit from mechanical thrombectomies, the timing, the best device to use and the role of combining this intervention with the administration of intravenous tPA.

Effect of Musical Hearing On Anxiety, Pain, and Cardiorespiratory Parameters in Cardiac Surgery: Study Protocol of a Randomized Clinical Trial

Background Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for the patient, which can cause several complications. Among the various strategies that aim to alleviate these phenomena is musical hearing as a non-pharmacological intervention. The aim of this study is to evaluate the effect of musical hearing on preoperative state-anxiety, postoperative pain, at rest and cough stimulus, and cardiorespiratory parameters in patients undergoing cardiac surgery. Methods A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who accept to participate in the research and sign the consent. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups, experimental (subjected to music listening for 20 minutes in the pre and postoperative period) or control (standard care in the pre and post -operative), using a randomization scheme generated by the website. The sample size calculation was obtained after conducting a pilot study. Discussion The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols of musical hearing, to minimize anxiety and pain in cardiac surgery. Trial registration: ReBEC RBR-8mdyhd. Posted on December 10, 2019, https://ensaiosclinicos.gov.br/rg/RBR-8mdyhd