The Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) recently released a superb article detailing the recommended treatment approach in TBI-patients with both cerebral tissue oximetry and ICP-monitoring. It provides an easy-to-follow and logical multi-tier algorithm for addressing various combinations of ICP/PbtO2 abnormalities. As such it offers a guidance document for clinical care that… Continue reading SIBICC: Management Algorithm for TBI-patients with both PbtO2 and ICP-monitoring
In December 2019 the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society and the Neuro Anaesthesia and Critical Care Society published their joint guidelines on how to safely transfer patients with acute brain injury to the appropriate level of care. Focusing on TBI and stroke-related brain injury, this consensus document outlines both… Continue reading Joint AAGBI & NACCS Guidelines on Safe Transfer of the Brain Injured Patient
The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) incoming president Dr. Deepak Sharma shares his thoughts as we approach the new year. Some valuable input to bring with us into the holidays. Read his newsletter here.
This month’s edition of Current Opinion in Anaesthesiology is replete with neuro-topics, ranging from awake craniotomy to complex spinal surgery and anaesthesia for stroke thrombectomy. Well worth a read, this collection of articles provides (often excellent) summaries of evidence and current practice in numerous fields relevant to the neuroanaesthetist.
The optimal hyperosmotic agent for treatment of intracranial hypertension following TBI has been an inexhaustible subject of debate. Scant evidence underlies these discussions despite widespread and long-standing use of both agents. In this article Anstey et al. retrospectively analysed data from 14 different centres to compare outcomes in mannitol-only and hypertonic saline-only cohorts. They excluded… Continue reading Mannitol vs. Hypertonic Saline in TBI – A Retrospective Study
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.
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
Intracerebral haemorrhage is associated with a number of haemodynamic consequences. These are not just limited to arrhythmias. Lele and colleagues have summarised the most common and important ones in this review in the Journal of Neurosurgical Anesthesiology.
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