General Topics · Neuroanaesthesia

Elevated serum lactate during craniotomies…

In the last issue of Journal of neurosurgical anesthesiology, there is an interesting article discussing elevated serum lactate during craniotomies. Brallier et al performed a retrospective cohort study of elective adult craniotomy cases (436 patients). They found that elevated intraoperative serum lactate in craniotomy patients is associated with new neurological deficits (odds ratio, 2.11) and longer length… Continue reading Elevated serum lactate during craniotomies…

Neurocritical Care · Neuromonitoring · Traumatic Brain Injury

Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial

Okonkwo et al, ten ICUs in the United States. Read their article in Critical Care Medicine, November 2017-issue. They found that management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue monitoring reduced brain tissue hypoxia, with a trend toward lower mortality and more favorable outcomes, compared with treatment guided by… Continue reading Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial

Coagulopathy and Bleeding · Neurotrauma · Traumatic Brain Injury

Crash-3 has enrolled 9653 patients!

Crash-2 showed that TXA reduced mortality due to bleeding and all-cause mortality in trauma patients with extra cranial bleeding. The Crash-3 trial will provide reliable evidence about the effect of TXA on mortality and disability in patients with TBI. the effect of TXA on the risk of vascular occlusive vents and seizures will also be… Continue reading Crash-3 has enrolled 9653 patients!

Airway Management · Cervical Spine Injury · Traumatic Brain Injury

A Few Handy Resources on Airway Management

Patients with head- and neck injuries can have challenging airways. We often use videolaryngoscopes or flexible fibrescopes (single use scope) when performing intubation in such patients. Our colleagues in Copenhagen have put together a useful website with videos and other learning resources on that subject. They also arrange an annual  two-day airway course with a very extensive workshop. Read more… Continue reading A Few Handy Resources on Airway Management

Airway Management · Neurocritical Care · Neurotrauma · Traumatic Brain Injury

More Brain Impact Apnoea

Brain impact apnoea causes secondary brain injury.  The duration of the apnoea reflects the energy in the injury. We often see these patients in our trauma center as they come intubated. CT-scan can reveal structural brain damage or bleeding. In some pastients the CT-scan is “normal”. However, the brain may have suffered hypoxic injuries undetectable with… Continue reading More Brain Impact Apnoea

Basic Sciences & Physiology · Neuromonitoring

Assessment of cerebral autoregulation patterns with NIRS during pharmacological induced pressure changes

Moerman et al, Anesthesiology Aug 2015. Link to PubMed here. In this study, paradoxical changes in ScO2 after pharmacological-induced pressure changes occurred exclusively in patients with intact cerebral autoregulation, corroborating the hypothesis that these paradoxical responses might be attributable to a functional cerebral autoregulation.