Basic Sciences & Physiology · Cardiovascular Conditions · General Topics · Haemodynamics · Neuroanaesthesia · Pharmacology · Traumatic Brain Injury

SNACC.org – Article of the Month: Effects of Vasopressors on Cerebral Circulation and Oxygenation

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.

Acute Cerebrovascular Conditions · Intracerebral Haemorrhage · Neurocritical Care · Neurovascular Surgery

ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome

The landmark 2016 ATACH II trial compared aggressive blood pressure lowering (110-139 mmHg) with standard BP-targets (140-180) in patients with spontaneous ICH, and found no difference between the groups. The main endpoints were mortality and functional neurological outcome (modified Rankin scale). The only discernible difference was a tendency towards less haematoma expansion in the intervention… Continue reading ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome

Acute Cerebrovascular Conditions · Air Embolism · Aneurysm Surgery · Cervical Spine Surgery · General Topics · Haemodynamics · ICP/CPP management · Intracranial Surgery General · Ischaemic Stroke · Neuroanaesthesia · Neuromonitoring · Neurovascular Surgery · Perioperative Management · Sedation · Seizure Control · Subarachnoid Haemorrhage · Thoracolumbar Spine Surgery · US Guidelines · Ventilation and Oxygenation

SNACC – How to Handle Neuroanaesthetic Emergencies

From our quality-focused colleagues at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) comes this set of guidelines for management of the most common emergencies encountered in neuroanaesthetic practice. Conceived with the purpose of addressing complex emergent issues in a concise, goal-directed and simplified manner, these cognitive aids are clear-cut and based on… Continue reading SNACC – How to Handle Neuroanaesthetic Emergencies

Fluid Management · Neuroanaesthesia · Osmotherapy · Paediatrics · Perioperative Management

Balanced Crystalloids Better Than Isotonic Saline for Craniotomy in Kids?

In this interesting trial by Lima and colleagues, with findings published recently in the Journal of Neurosurgical Anesthesiology, the authors compare normal saline (NS) with a balanced crystalloid as a maintenance fluid for elective tumour resection in paediatric patients. Their main endpoint was change in serum chloride from baseline to end of surgery. Perhaps unsurprisingly… Continue reading Balanced Crystalloids Better Than Isotonic Saline for Craniotomy in Kids?

Acute Cerebrovascular Conditions · Ischaemic Stroke · Neurovascular Surgery

Recent study in JACC – Procedure Time in Stroke Thrombectomies Has Impact on Outcomes

Endovascular thrombectomy is a cornerstone of ischaemic stroke managament. Time from stroke to intervention has been clearly linked to functional outcome (1) and is a key metric to which much attention is devoted. But what about the duration of the procedure itself? Earlier data has suggested that length of procedure may affect functional outcomes after… Continue reading Recent study in JACC – Procedure Time in Stroke Thrombectomies Has Impact on Outcomes

Basic Sciences & Physiology · Fluid Management · General Topics · Neurocritical Care · Neuroprotection · Osmotherapy

Hyponatraemia and the Brain – Review

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.