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?

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.

Acute Cerebrovascular Conditions · European Guidelines · Fluid Management · Haemodynamics · Osmotherapy · Subarachnoid Haemorrhage · Traumatic Brain Injury

Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation

Just published: the European Society of Intensive Care Medicine´s consensus document on fluid administration in the NICU. It covers all manner of neurocritical conditions and sums up the available evidence for various fluid therapy approaches. As expected there are few recommendations that aren´t already well established and by now fairly uncontroversial (multimodal monitoring, avoiding colloids,… Continue reading Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation

Fluid Management · Haemodynamics · Osmotherapy · Subarachnoid Haemorrhage · TBI General

Critical Care: Fluid Therapy in Neurological Patients

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

ICP/CPP management · Intracranial Surgery General · Osmotherapy

Cochrane Review – Mannitol vs. HS in Patients Undergoing Craniotomy

Cochrane review from 2014: Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. By Prabhakar et al.   “From the limited data available on the use of mannitol and hypertonic saline for brain relaxation during craniotomy, it is suggested that hypertonic saline significantly reduces the risk of tense brain during craniotomy”