SNACC’s article of the month for July is an excellent narrative review on the pharmacodynamics of vasopressors in health and in the setting of brain injury. The review is preceded by an introductory commentary by neuroscand.com contributor Dr. Riikka Takala.
Just a quick update on two recent trials on pharmacological treatment for status epileptics in children: Both articles were published in the Lancet this spring. ConSEPT and EcLiPSE, both high-quality trials, found levetiracetam and phenytoin to be equally effective in seizure control and similar in safety profile. The findings were be remarkably consistent across the… Continue reading ConSEPT and EcLiPSE Trials: Levetiracetam Equal to Phenytoin in Efficacy for Convulsive Status Epilepticus in Children
The ever-increasing use of direct (or novel) oral anticoagulants (DOACs) has had a profound effect on primary and secondary prevention of thromboembolic events, especially in the elderly. Whilst many patients benefit from switching over to these newer drugs from older anticoagulants like warfarin, thus foregoing such nuisances as INR-guided dosing, they have also inevitably led… Continue reading Impact of DOACs in TBI in the over 60s
Lactate is well-known as an important energy substrate for brain tissue and plays a key role in neuroenergetics. Experimental data have shown that exogenous lactate administration may improve metabolism in injured brain cells, and possibly has neuroprotective properties. Till now there has been a paucity of human clinical studies on this subject. Carteron et al… Continue reading Lactate Improves Cerebral Perfusion After Acute Brain Injury – Recent Clinical Trial in Crit Care Med
I came across this useful little review in Kidney International Reports covering a subject I always find difficult to grasp: sodium disturbances and their influence on the brain. The article delves into the matter in a concise and understandable way, making it just about manageable even for an anaesthetist.
Tranexamic acid (TXA) has been held as something of a wonder drug. It’s cheap, largely demonstrated to be safe and has been given a role in a number of settings. The 2013 CRASH-2 trial showed improved survival in trauma with bleeding, and thus became one of the most widely cited publications in traumatology and emergency medicine. Several… Continue reading TICH-2: No Benefit From TXA in ICH. What Now?
We covered the subject of beta-blockade in traumatic brain injury last autumn in this article, where we summarised the increasing evidence that it seems to improve survival. A recently published trial (free full text) in the Journal of Trauma and Acute Care Surgery adds further credence to the role of beta-blockers in this patient group. This… Continue reading Another Trial Suggesting Beta-blockers Are Beneficial in TBI: Time for an RCT!
Christmas and New Years is usually fairly dormant in terms of publications, but a few worth mentioning have surfaced. This recent meta-analysis of gabapentin as an analgaesic adjunct in spinal surgery was published in Pain Physician by Han et al. The group included 10 trials, covering 827 patients, and found significantly reduced postoperative morphine consumption,… Continue reading Gabapentin and Spinal Surgery – a Meta-analysis
We all recall the elegant curves that ostensibly show the neat relationship between mean arterial blood pressure (or CPP) and cerebral blood flow. This relationship classically has its lower and upper limits, beyond which CBF will vary passively with the systemic pressure. Stay within these limits and all is good, the mantra goes. However, as… Continue reading Cerebral Autoregulation – What do we know?
This is a subject that has been on our backburner for a while and it’s now due for a discussion on neuroscand.com. The use of beta-blockers in traumatic brain injury is nothing new. The indications have been largely centered on targeting and preventing paroxysmal sympathetic hyperactivity (PSH) and associated post-TBI autonomic phenomena. Please see our… Continue reading Beta-blockers and TBI