In the last issue of Journal of neurosurgical anesthesiologgy, there is an interesting article discussing elevated serum lactate during craniotomies. Brallier et al performed a retrospective cohort study of elective adult craniotomy cases (436 patients). They found that elevated intraoperative serum lactate in craniotomy patients is associated with new neurological deficits (odds ratio, 2.11) and longer length… Continue reading Elevated serum lactate during craniotomies…
We all recall the elegant curves that ostensibly show the neat relationship between mean arterial blood pressure (or CPP) and cerebral blood flow. This relationship classically has its lower and upper limits, beyond which CBF will vary passively with the systemic pressure. Stay within these limits and all is good, the mantra goes. However, as… Continue reading Cerebral Autoregulation – What do we know?
Targeted temperature management (TTM) as a neuroptotective strategy is applied in a number of scenarios; post-ROSC in cardiac arrest, neonatal asphyxia, traumatic brain injury, to name some. The Neurocritical Care Society have taken it upon themselves to formulate an evidence-based guideline to the implementation and practical management of TTM in a number of settings. Although… Continue reading TTM – New Guidelines from NCS
Okonkwo et al, ten ICUs in the United States. Read their article in Critical Care Medicine, November 2017-issue. They found that management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue monitoring reduced brain tissue hypoxia, with a trend toward lower mortality and more favorable outcomes, compared with treatment guided by… Continue reading Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial
This is a subject that has been on our backburner for a while and it’s now due for a discussion on neuroscand.com. The use of beta-blockers in traumatic brain injury is nothing new. The indications have been largely centered on targeting and preventing paroxysmal sympathetic hyperactivity (PSH) and associated post-TBI autonomic phenomena. Please see our… Continue reading Beta-blockers and TBI
Subarachnoid haemorrhage and traumatic brain injury can cause Terson syndrome, a bleeding in corpus vitreum. Read the study by Narayanan et al: ““Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury”. Our neurosurgeons suggest ophthalmoscopy once a week. Look for loss of red reflex.
Here’s a few resources on anaesthesia for awake craniotomies that have recently come to our attention, thanks to some of our colleagues: The first, from UpToDate, was updated this year. The second is part of the British Journal of Anaesthesia’s Continuing Education in Anaesthesia Critical Care & Pain series. It dates back to 2013 but is still… Continue reading Awake Craniotomy: Useful Resources