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Brain injury sedation

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https://www.readbyqxmd.com/read/29756489/sevoflurane-exerts-brain-protective-effects-against-sepsis-associated-encephalopathy-and-memory-impairment-through-caspase-3-9-and-bax-bcl-signaling-pathway-in-a-rat-model-of-sepsis
#1
Nurdan Bedirli, Emin Umit Bagriacik, Guldal Yilmaz, Zerrin Ozkose, Mustafa Kavutçu, Aslı Cavunt Bayraktar, Abdulkadir Bedirli
Objective We compared the effects of sevoflurane and isoflurane on systemic inflammation, sepsis-associated encephalopathy, and memory impairment in a rat sepsis model of cecal ligation and puncture (CLP)-induced polymicrobial peritonitis. Methods Twenty-four rats were assigned to sham, CLP, CLP + sevoflurane, and CLP + isoflurane groups. At 72 hours after CLP, the rats underwent behavior tests. Serum cytokines were evaluated. Brain tissue samples were collected for determination of glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase; the wet/dry weight ratio; myeloperoxidase (MPO) and malondialdehyde (MDA); apoptotic gene release; and histologic examinations...
January 1, 2018: Journal of International Medical Research
https://www.readbyqxmd.com/read/29742216/pain-assessment-of-traumatic-brain-injury-victims-using-the-brazilian-version-of-the-behavioral-pain-scale
#2
Caíque Jordan Nunes Ribeiro, Andra Carla Santos de Araújo, Saulo Barreto Brito, Daniele Vieira Dantas, Mariangela da Silva Nunes, José Antonio Barreto Alves, Maria do Carmo de Oliveira Ribeiro
OBJECTIVE: To evaluate the validity and reliability of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in victims of traumatic brain injury. METHODS: Observational prospective study with paired and repeated measures conducted at two intensive care units (clinical and surgical) of a large general hospital. The convenience sample consisted of adult victims of moderate or severe penetrating or blunt craniocerebral trauma who were sedated and mechanically ventilated...
March 2018: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29727362/effect-of-body-temperature-on-cerebral-autoregulation-in-acutely-comatose-neurocritically-ill-patients
#3
Krishma Adatia, Romergryko G Geocadin, Ryan Healy, Wendy Ziai, Luciano Ponce-Mejia, Mirinda Anderson-White, Dhaval Shah, Batya R Radzik, Caitlin Palmisano, Charles W Hogue, Charles Brown, Lucia Rivera-Lara
OBJECTIVES: Impaired cerebral autoregulation following neurologic injury is a predictor of poor clinical outcome. We aimed to assess the relationship between body temperature and cerebral autoregulation in comatose patients. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Neurocritical care unit of the Johns Hopkins Hospital. PATIENTS: Eighty-five acutely comatose patients (Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017...
May 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29679696/effect-of-neuromonitor-guided-titrated-care-on-brain-tissue-hypoxia-after-opioid-overdose-cardiac-arrest
#4
Jonathan Elmer, Katharyn L Flickinger, Maighdlin W Anderson, Allison Koller, Matthew Sundermann, Cameron Dezfulian, David O Okonkwo, Lori A Shutter, David Salcido, Clifton W Callaway, James J Menegazzi
INTRODUCTION: Brain tissue hypoxia may contribute to preventable secondary brain injury after cardiac arrest. We developed a porcine model of opioid overdose cardiac arrest and post-arrest care including invasive, multimodal neurological monitoring of regional brain physiology. We hypothesized brain tissue hypoxia is common with usual post-arrest care and can be prevented by modifying mean arterial pressure (MAP) and arterial oxygen concentration (PaO2 ). METHODS: We induced opioid overdose and cardiac arrest in sixteen swine, attempted resuscitation after 9 minutes of apnea, and randomized resuscitated animals to three alternating 6-hour blocks of standard or titrated care...
April 18, 2018: Resuscitation
https://www.readbyqxmd.com/read/29678142/abnormally-low-bispectral-index-and-severe-hypoglycemia-during-maintenance-of-and-recovery-from-general-anesthesia-in-diabetic-retinopathy-surgery-two-case-reports
#5
Chunhua Xi, Chuxiong Pan, Tianzuo Li
BACKGROUND: Hypoglycemia is one of the most fatal complications during the perioperative period. General anesthesia or sedation can mask a hypoglycemia-altered mental status. Acute hypoglycemia might result in permanent brain injury. There is no way to detect hypoglycemia during general anesthesia, except for intermittent blood glucose monitoring. CASE PRESENTATION: Hypoglycemia is associated with changes in electroencephalogram readings. Here, we report two cases of patients with an abnormally low Bispectral Index (BIS) associated with diabetic retinopathy surgery, one in the recovery stage of general anesthesia and the other in the maintenance of general anesthesia...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29673289/systematic-review-of-the-pharmacological-agents-that-have-been-tested-against-spreading-depolarizations
#6
Anna Klass, Renan Sánchez-Porras, Edgar Santos
Spreading depolarization (SD) occurs alongside brain injuries and it can lead to neuronal damage. Therefore, pharmacological modulation of SD can constitute a therapeutic approach to reduce its detrimental effects and to improve the clinical outcome of patients. The major objective of this article was to produce a systematic review of all the drugs that have been tested against SD. Of the substances that have been examined, most have been shown to modulate certain SD characteristics. Only a few have succeeded in significantly inhibiting SD...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29653188/ketamine-reduces-deleterious-consequences-of-spreading-depolarizations
#7
Katelyn M Reinhart, C William Shuttleworth
Recent work has implicated spreading depolarization (SD) as a key contributor the progression of acute brain injuries, however development of interventions selectively targeting SDs has lagged behind. Initial clinical intervention efforts have focused on observations that relatively high doses of the sedative agent ketamine can completely suppress SD. However blocking propagation of SD could theoretically prevent beneficial effects of SD in surrounding brain regions. Selective targeting of deleterious consequences of SD (rather than abolition) could be a useful adjunct approach, and be achieved with lower ketamine concentrations...
April 10, 2018: Experimental Neurology
https://www.readbyqxmd.com/read/29596288/management-of-intracranial-pressure-part-i-pharmacologic-interventions
#8
Tara L Sacco, Samantha A Delibert
Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed...
May 2018: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/29579815/utility-of-transcranial-doppler-in-the-coordination-of-transplants-10-years-of-experience
#9
A Cacciatori, M Godino, R Mizraji
Transcranial Doppler (TCD) integrated to multimodal neuromonitoring of neurocritical patients is a useful tool in the clinical follow-up. A retrospective and descriptive study of 194 patients who were admitted into the intensive care unit (ICU) was carried out from December 2007 to February 2017. We analyzed the distribution of study frequencies with respect to the pathologies that motivated them, the characteristics of patients who evolved to brain death (BD), and most frequent patterns of cerebral circulatory arrest...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29563509/neuroprotective-effect-of-dexmedetomidine-in-a-murine-model-of-traumatic-brain-injury
#10
Jin Wu, Todd Vogel, Xiang Gao, Bin Lin, Charles Kulwin, Jinhui Chen
No FDA approved pharmacological therapy is available that would reduce cell death following traumatic brain injury (TBI). Dexmedetomidine (Dex) is a highly selective agonist of alpha-2 adrenergic receptors and has demonstrated neuroprotective effects in hippocampal slice cultures undergoing direct impact. However, no one has tested whether Dex, in addition to its sedative action, has neuroprotective effects in an animal model of TBI. Thus, in the present study, we investigated the effects of Dex on an animal model of TBI...
March 21, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29556697/mri-in-mild-pediatric-traumatic-brain-injury-diagnostic-overkill-or-useful-tool
#11
Gesa Cohrs, Monika Huhndorf, Nils Niemczyk, Lukas J Volz, Alexander Bernsmeier, Ash Singhal, Naomi Larsen, Michael Synowitz, Friederike Knerlich-Lukoschus
PURPOSE: Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI. METHODS: Children (0-18 years, sub-divided in four age-groups) with mild TBI who received MRI in the emergency department were identified...
March 19, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29508705/clinical-phenotypes-of-delirium-during-critical-illness-and-severity-of-subsequent-long-term-cognitive-impairment-a-prospective-cohort-study
#12
Timothy D Girard, Jennifer L Thompson, Pratik P Pandharipande, Nathan E Brummel, James C Jackson, Mayur B Patel, Christopher G Hughes, Rameela Chandrasekhar, Brenda T Pun, Leanne M Boehm, Mark R Elstad, Richard B Goodman, Gordon R Bernard, Robert S Dittus, E W Ely
BACKGROUND: Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment. METHODS: In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study...
March 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29502712/management-of-traumatic-brain-injury-an-update
#13
REVIEW
Mohamed H Abou El Fadl, Kristine H O'Phelan
The care of patients with traumatic brain injury can be one of the most challenging and rewarding aspects of clinical neurocritical care. This article reviews the approach to unique aspects specific to the care of this patient population. These aspects include appropriate use of sedation and analgesia, and the principles and the clinical use of intracranial monitors. Common clinical challenges encountered in these patients are also discussed, including the treatment of intracranial hypertension, temperature management, and control of sympathetic hyperactivity...
April 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29492533/is-there-a-relationship-between-optimal-cerebral-perfusion-pressure-guided-management-and-pao-2-fio-2-ratio-after-severe-traumatic-brain-injury
#14
M Moreira, D Fernandes, E Pereira, E Monteiro, R Pascoa, C Dias
OBJECTIVE: Severe traumatic brain injury (TBI) management has been associated with adult respiratory distress syndrome (ARDS) in previous literature. We aimed to investigate the relationships between optimal CPP-guided management, ventilation parameters over time and outcome after severe TBI. MATERIALS AND METHODS: We performed retrospective analysis of recorded data from 38 patients admitted to the NCCU after severe TBI, managed with optimal cerebral perfusion pressure (CPPopt)-guided therapy, calculated using pressure reactivity index (PRx)...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29452802/moving-to-human-trials-for-argon-neuroprotection-in-neurological-injury-a-narrative-review
#15
REVIEW
A J Gardner, D K Menon
Despite the global burden of brain injury, neuroprotective agents remain elusive. There are no clinically effective therapies which reduce mortality or improve long-term cognitive outcome. Ventilation could be an easily modifiable variable in resuscitation; gases are relatively simple to administer. Xenon is the prototypic agent of a new generation of experimental treatments which show promise. However, use is hindered by its prohibitive cost and anaesthetic properties. Argon is an attractive option, being cheaper, easy to transport, non-sedating, and mechanistically distinct from xenon...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29420701/cerebellar-functional-connectivity-in-term-and-very-preterm-born-infants
#16
Charlotte S Herzmann, Abraham Z Snyder, Jeanette K Kenley, Cynthia E Rogers, Joshua S Shimony, Christopher D Smyser
Cortical resting state networks have been consistently identified in infants using resting state-functional connectivity magnetic resonance imaging (rs-fMRI). Comparable studies in adults have demonstrated cerebellar components of well-established cerebral networks. However, there has been limited investigation of early cerebellar functional connectivity. We acquired non-sedated rs-fMRI data in the first week of life in 57 healthy, term-born infants and at term-equivalent postmenstrual age in 20 very preterm infants (mean birth gestational age 27 ± 2 weeks) without significant cerebral or cerebellar injury...
February 6, 2018: Cerebral Cortex
https://www.readbyqxmd.com/read/29413725/current-practices-and-safety-of-medication-use-during-rapid-sequence-intubation
#17
Christine M Groth, Nicole M Acquisto, Tina Khadem
PURPOSE: Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events. MATERIALS AND METHODS: This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation. RESULTS: A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%)...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29405355/cortisol-evaluation-during-the-acute-phase-of-traumatic-brain-injury-a-prospective-study
#18
Meriem Bensalah, Malcolm Donaldson, Yamina Aribi, Malek Iabassen, Lyes Cherfi, Mustapha Nebbal, Meriem Medjaher, ElMehdi Haffaf, Benaissa Abdennebi, Kamel Guenane, Adel Djermane, Zahra Kemali, Samia OuldKablia
BACKGROUND: Biochemical diagnosis of adrenal insufficiency (AI) is difficult in the context of traumatic brain injury (TBI). AIM: To assess the frequency and predictive factors of AI in victims of TBI from Algiers. METHODS: Between November 2009 and December 2013, TBI victims had a single 8-9 am serum cortisol measurement during the acute postinjury period (0-7 days). AI was defined according to basal cortisol levels of 83, 276 and 414 nmol/L...
May 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29389771/early-electroencephalography-findings-in-cardiogenic-shock-patients-treated-by-venoarterial-extracorporeal-membrane-oxygenation
#19
Fabrice Sinnah, Marie-Amélie Dalloz, Eric Magalhaes, Ruben Wanono, Mathilde Neuville, Roland Smonig, Aguila Radjou, Bruno Mourvillier, Lila Bouadma, Jean-François Timsit, Marie-Pia d'Ortho, Any Rouvel-Tallec, Romain Sonneville
OBJECTIVES: We aimed to assess early electroencephalography findings in patients treated by venoarterial extracorporeal membrane oxygenation and their association with neurologic outcome. DESIGN: Single-center observational study. SETTING: Medical ICU of a university hospital. PATIENTS: An early standardized electroencephalography assessment, that is, standard electroencephalography followed by continuous electroencephalography, was performed in consecutive cardiogenic shock patients requiring venoarterial extracorporeal membrane oxygenation...
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29329164/a-systematic-review-of-risk-factors-associated-with-cognitive-impairment-after-pediatric-critical-illness
#20
Alicia G Kachmar, Sharon Y Irving, Cynthia A Connolly, Martha A Q Curley
OBJECTIVES: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. DATA SOURCES: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. STUDY SELECTION: Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension...
March 2018: Pediatric Critical Care Medicine
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