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…
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
Subarachnoid haemorrhage and traumatic brain injury can cause Terson syndrome, a bleeding in corpus vitreum. Read the study by Narayanan et al: ““Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury”. Our neurosurgeons suggest ophthalmoscopy once a week. Look for loss of red reflex.
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!
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
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
Watch this lecture by Michael Avidan, Washington University School of Medicine. Introduction and clinical use of EEG. Another resource are the learning modules of Partners Healthcare. Register for free at www.anesthesiaeeg.com.
Brain Trauma Foundation has just published the 4th edition of Guidelines for the Management of Severe TBI. Study the guidelines here.
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.
Listen to Per Bredmose and how to use ketamine. We often use it inhospital in the initially treatment of traumapatients: traumatic brain injury and other injuries, often together with titrated doses of diazepam and fentanyl. Be aware of the sympatomimetic effect and hypertensive episodes in patients with Sah/ aneurysms. Link to the podcast.