Does choice of anaesthetic approach have an impact on neurological outcomes in stroke patients? This article, recently published in Stroke, examines outcomes in patients undergoing endovascular treatment for acute ischemic stroke, randomised to either conscious sedation or general anaesthesia. Retrospective material till now has suggested poorer outcomes in patients subjected to full anaesthesia when compared… Continue reading AnStroke Trial: Anaesthesia vs. Sedation for Endovascular Treatment of Ischemic Stroke
This narrative review by Green et al (full text) was published recently in Anaesthesia. It explores the existing literature on the use of near-infrared spectroscopy cerebral oximetry in various settings, including surgery and resuscitation from cardiac arrest.
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
Follow the link to read the article: http://jamanetwork.com/journals/jama/fullarticle/2577957
In a recent article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Pakkanen et al, retrospective data from a Finnish prehospital service is presented. They looked at prehospital management of severe TBI (severe head injury with GCS 8 or lower) over a 6-year period, including some 458 patients for analysis. They found a… Continue reading SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI
Right off the press: an open access review article from Critical Care on fluid therapy in the neurological patient. It provides a nice synopsis of the different fluid therapy paradigms that are advocated through various guidelines. The review challenges some of the tenets of basic treatment, such as empirical fluid maintenance and the definition of… Continue reading Critical Care: Fluid Therapy in Neurological Patients
Immediate apnea after acute head trauma is a concept that has received renewed focus lately. BIA/IBA (Brain Impact Apnea or as some call it, Impact Brain Apnea) was described in animal models as far back as 1874 by Koch and Filehne (1). A number of subsequent studies (2-5) have established a clear link between severity of impact and duration of… Continue reading Brain Impact Apnea
Life in The Fast Lane´s take on the use of ketamine in traumatic brain injury. Nice summary of available literature. Sums it up succinctly for those who are still reluctant to use ketamine in this patient group. For more on the same subject, see this article on ketamine and ICP.
“Dry them out”; use glycopyrrolate (no central effects). How to use local anesthetics and more… emcrit.org Listen to the podcast here. EMcrit recommend: Airway Regional Anesthesia for Awake Fiberoptic Intubation, Simmons et al, Regional Anesthesia and Pain Medicine 2002. Read the review article here. Fibreoptic vs videolaryngoscopic (C-MAC(®) D-BLADE) nasal awake intubation under local anesthesia. Kramer et al. Anaesthesia. 2015… Continue reading Awake Intubation Lecture from SMACC