Really interesting article in the latest issue of JAMA Neurology: Specific EEG changes, known as periodic discharges (PDs), seem to be of value in predicting brain tissue hypoxia in vulnerable patients with acute brain injury. In this investigation, Witsch and colleagues included 90 patients with high-grade subarachnoid haemorrhage and monitored them with continuous EEG in addition to… Continue reading EEG and Oxygenation in Acute Brain Injury
Published in 2011 by Schmidt et al (free full-text in Stroke), this article looks at CPP thresholds for cerebral hypoxia in SAH patients. They went through multimodal monitoring data for 30 patients with poor-grade SAH. Using microdialysis and brain tissue oxygenation as their main determinants of hypoxia, they found that patients with a CPP <70… Continue reading Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage
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
Systematic review, Cochrane march 2016. Li et al. Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm. The authors did not identify any reliable evidence to support the routine use of intraoperative mild hypothermia. Read more here.
A very worthwhile and insightful overview of SAH management in the acute phase. Courtesy of Continuing Education in Anaesthesia, Critical Care & Pain. Read it here.
A quick run-through on acute care of subarachnoid haemorrhage patiefnts by the always-relevant Life In The Fast Lane guys.
“.. infusion of 2 ml kg(-1) during 20 min has a predictable and clinically significant beneficial effect on ICP and CPP.” Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid hemorrhage. Bentsen et al, Norway. Acta Anaesthesiologica Scandinavica, 2004 Oct. Read the abstract here. Hypertonic… Continue reading SAH-patients: HyperHaes and reduction in ICP (2004)
“There was no difference in the incidence of impairment between hypothermic and normothermic groups” Abstract: Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery. Ann Neurol 2006. Anderson et al.
Free full-text via PubMed at: Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. Todd et al. NEJM 2005. “Intraoperative hypothermia did not improve the neurologic outcome after craniotomy among good-grade patients with aneurysmal subarachnoid haemorrhage”
“Adenosine cardiac arrest is a relatively novel method for decompression of intracranial aneurysms to facilitate clip application. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of proximal vessels is not desirable or not possible” Abstract from the Journal of Neurosurgical Anaesthesiology. 2011: Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective… Continue reading Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review