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Brain injury sedation

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https://www.readbyqxmd.com/read/28534652/a-review-of-the-evidence-of-zolpidem-efficacy-in-neurological-disability-after-brain-damage-due-to-stroke-trauma-and-hypoxia-a-justification-of-further-clinical-trials
#1
J A Sutton, R P Clauss
During 15 years, 23 clinical reports and 6 studies have demonstrated associations between sub-sedative doses of zolpidem and recoveries from brain damage due to strokes, trauma and hypoxia. Clinical findings include unexpected awakenings from vegetative states and regressions of stroke symptoms after dosing that disappear during elimination and reappear on repeat dosing. Initially single-photon emission computed tomography scans showed improved perfusion within, around and distant from infarctions. Then positron emission tomography scans and electroencephalography detected renewed metabolic and neuronal activity...
May 23, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28484929/functional-mri-for-assessment-of-the-default-mode-network-in-acute-brain-injury
#2
Daniel Kondziella, Patrick M Fisher, Vibeke Andrée Larsen, John Hauerberg, Martin Fabricius, Kirsten Møller, Gitte Moos Knudsen
BACKGROUND: Assessment of the default mode network (DMN) using resting-state functional magnetic resonance imaging (fMRI) may improve assessment of the level of consciousness in chronic brain injury, and therefore, fMRI may also have prognostic value in acute brain injury. However, fMRI is much more challenging in critically ill patients because of cardiovascular vulnerability, intravenous sedation, and artificial ventilation. METHODS: Using resting-state fMRI, we investigated the DMN in a convenience sample of patients with acute brain injury admitted to the intensive care unit...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28463790/dexmedetomidine-inhibits-activation-of-the-mapk-pathway-and-protects-pc12-and-ng108-15-cells-from-lidocaine-induced-cytotoxicity-at-its-maximum-safe-dose
#3
Qiong Wang, Yonghong Tan, Na Zhang, Yingyi Xu, Wei Wei, Yingjun She, Xiaobao Bi, Baisong Zhao, Xiangcai Ruan
The developing brains of pediatric patients are highly vulnerable to anesthetic regimen (e.g., lidocaine), potentially causing neurological impairment. Recently, dexmedetomidine (DEX) has been used as an adjunct for sedation, and was shown to exert dose-dependent neuroprotective effects during brain injury. However, the maximum safe dose of DEX is unclear, and its protective effects against lidocaine-related neurotoxicity need to be confirmed. In this study, PC12 and NG108-15 cells were used to estimate safe, non-cytotoxic doses of DEX...
April 29, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#4
James L Hungerford, Nicole O'Brien, Melissa Moore-Clingenpeel, Eric A Sribnick, Cheryl Sargel, Mark Hall, Jeffrey R Leonard, Joseph D Tobias
OBJECTIVE: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 2...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28409034/increased-intracranial-pressure-during-hemodialysis-in-a-patient-with-anoxic-brain-injury
#5
Anton Lund, Mette B Damholt, Ditte G Strange, Jesper Kelsen, Hasse Møller-Sørensen, Kirsten Møller
Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28377246/awake-surgery-for-brain-vascular-malformations-and-moyamoya-disease
#6
Rami James N Aoun, Mithun G Sattur, Chandan Krishna, Amen Gupta, Matthew E Welz, Allan D Nanney, Antoun H Koht, Matthew C Tate, Katherine H Noe, Joseph I Sirven, Barrett J Anderies, Patrick B Bolton, Terry L Trentman, Richard S Zimmerman, Kristin R Swanson, Bernard R Bendok
OBJECTIVE: While a significant amount of experience has accumulated for awake procedures for brain tumor, epilepsy and carotid surgery, its utility for intracranial neurovascular indications remains largely undefined. Awake surgery, for select neurovascular cases, offers the advantage of precise brain mapping and robust neurological monitoring during surgery for lesions in eloquent areas, avoidance of potential hemodynamic instability, and possible faster recovery. Additionally, it opens the window for perilesional epileptogenic tissue resection with potentially less risk for iatrogenic injury...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28372905/apoe-%C3%AE%C2%B54-positive-patients-suffering-severe-traumatic-head-injury-are-more-prone-to-undergo-decompressive-hemicraniectomy
#7
Zandra Olivecrona, Lars-Owe D Koskinen
OBJECT: In this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) ε4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control. METHODS: In this prospective consecutive study patients with sTBI were enrolled (n=48). Inclusion criteria were arrival to our level one trauma university hospital within 24h after trauma, patient age between 15 and 70years, Glasgow Coma Scale (GCS) score ≤8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10mmHg...
March 31, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28343228/focal-brain-injury-associated-with-a-model-of-severe-hypoxic-ischemic-encephalopathy-in-nonhuman-primates
#8
Ryan M McAdams, Ronald J McPherson, Raj P Kapur, Sandra E Juul
Worldwide, hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal mortality and morbidity. To better understand the mechanisms contributing to brain injury and improve outcomes in neonates with HIE, better preclinical animal models that mimic the clinical situation following birth asphyxia in term newborns are needed. In an effort to achieve this goal, we modified our nonhuman primate model of HIE induced by in utero umbilical cord occlusion (UCO) to include postnatal hypoxic episodes, in order to simulate apneic events in human neonates with HIE...
March 25, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28336376/effect-of-anesthetics-on-microglial-activation-and-nanoparticle-uptake-implications-for-drug-delivery-in-traumatic-brain-injury
#9
Gokul Kannan, Siva P Kambhampati, Sapna R Kudchadkar
Traumatic brain injury (TBI) is a serious public health problem, often with devastating consequences for patients and their families. Affordable and timely therapies can have a substantial impact on outcomes in severe TBI. Despite the common use of sedatives and anesthetics in the acute phase of TBI management, their effect on glial cells is not well understood. We investigated the effect of a commonly used sedative, pentobarbital, on glial cells and their uptake of nanoparticles. First, we studied how pentobarbital affects BV2 mouse microglial cells in culture...
March 20, 2017: Journal of Controlled Release: Official Journal of the Controlled Release Society
https://www.readbyqxmd.com/read/28229021/the-preventive-effect-of-dexmedetomidine-on-paroxysmal-sympathetic-hyperactivity-in-severe-traumatic-brain-injury-patients-who-have-undergone-surgery-a-retrospective-study
#10
Qilin Tang, Xiang Wu, Weiji Weng, Hongpeng Li, Junfeng Feng, Qing Mao, Guoyi Gao, Jiyao Jiang
BACKGROUND: Paroxysmal sympathetic hyperactivity (PSH) results and aggravates in secondary brain injury, which seriously affects the prognosis of severe traumatic brain injury patients. Although several studies have focused on the treatment of PSH, few have concentrated on its prevention. METHODS: Ninety post-operation (post-op) severe traumatic brain injury (sTBI) patients admitted from October 2014 to April 2016 were chosen to participate in this study. Fifty of the post-op sTBI patients were sedated with dexmedetomidine and were referred as the "dexmedetomidine group" (admitted from May 2015 to April 2016)...
2017: PeerJ
https://www.readbyqxmd.com/read/28187815/principles-of-intracranial-pressure-monitoring-and-treatment
#11
REVIEW
M Czosnyka, J D Pickard, L A Steiner
Intracranial pressure (ICP) is governed by volumes of intracranial blood, cerebrospinal fluid, and brain tissue. Expansion of any of these volumes will trigger compensatory changes in the other compartments, resulting in initially limited change in ICP. Due to the rigid skull, once compensatory mechanisms are exhausted, ICP rises very rapidly. Intracranial hypertension is associated with unfavorable outcome in brain-injured patients. This chapter discusses the pathophysiology of raised ICP, as well as typical waveforms, monitoring techniques, and clinical management...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28171804/hemodynamic-and-neuro-monitoring-for-neurocritically-ill-patients-an-international-survey-of-intensivists
#12
Sanjeev Sivakumar, Fabio S Taccone, Mohammed Rehman, Holly Hinson, Neeraj Naval, Christos Lazaridis
PURPOSE: To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). METHODS: Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. RESULTS: Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28168412/neuroprognostication-after-adult-cardiac-arrest-treated-with-targeted-temperature-management-task-force-for-belgian-recommendations
#13
REVIEW
Fabio Silvio Taccone, Ingrid Baar, Cathy De Deyne, Patrick Druwe, Benjamin Legros, Geert Meyfroidt, Michel Ossemann, Nicolas Gaspard
The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors...
March 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28158247/neuroprotective-effects-of-dexmedetomidine-against-hyperoxia-induced-injury-in-the-developing-rat-brain
#14
Stefanie Endesfelder, Hanan Makki, Clarissa von Haefen, Claudia D Spies, Christoph Bührer, Marco Sifringer
Dexmedetomidine (DEX) is a highly selective agonist of α2-receptors with sedative, anxiolytic, and analgesic properties. Neuroprotective effects of dexmedetomidine have been reported in various brain injury models. In the present study, we investigated the effects of dexmedetomidine on hippocampal neurogenesis, specifically the proliferation capacity and maturation of neurons and neuronal plasticity following the induction of hyperoxia in neonatal rats. Six-day old sex-matched Wistar rats were exposed to 80% oxygen or room air for 24 h and treated with 1, 5 or 10 μg/kg of dexmedetomidine or normal saline...
2017: PloS One
https://www.readbyqxmd.com/read/28148613/delirium-in-trauma-patients-prevalence-and-predictors
#15
Kathryn T Von Rueden, Breighanna Wallizer, Paul Thurman, Karen McQuillan, Tiffany Andrews, Jennifer Merenda, Heesook Son
BACKGROUND: Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit. OBJECTIVES: To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center. METHODS: Trauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit...
February 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28147421/blood-biomarkers-of-hypoxic-ischemic-brain-injury-after-cardiac-arrest
#16
Pascal Stammet
Biomarkers are part of the recommended outcome predictors after cardiac arrest. In general, blood biomarkers can easily be performed as routine laboratory tests, and they are unaffected by sedation, but bear the potential risk of laboratory errors. Nonetheless, if used properly, with the potential limitations in mind, they certainly help predict outcome after cardiac arrest. Among the routinely used and available blood biomarkers, neuron-specific enolase (NSE) has the best predictive value for poor outcome if measured serially from 24 to 72 hours...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28123622/full-outline-of-unresponsiveness-score-and-the-glasgow-coma-scale-in-prediction-of-pediatric-coma
#17
Atahar Jamal, Naveen Sankhyan, Murlidharan Jayashree, Sunit Singhi, Pratibha Singhi
BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) as predictors of outcome in children with impaired consciousness. METHODS: In this observational study, children (5-12 years) with impaired consciousness of <7 days were included. Children with traumatic brain injury, on sedatives or neuromuscular blockade; with pre-existing cerebral palsy, mental retardation, degenerative brain disease, vision/hearing impairment; and seizure within last 1 hour were excluded...
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28111062/psychotropic-medication-use-among-medicare-beneficiaries-following-traumatic-brain-injury
#18
Jennifer S Albrecht, Daniel C Mullins, Gordon S Smith, Vani Rao
OBJECTIVES: To characterize psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. A secondary objective is to determine how receipt of indicated pharmacologic treatment for anxiety and post-traumatic stress disorder (PTSD) differs following TBI. DESIGN: Retrospective cohort. SETTING: United States. PARTICIPANTS: Medicare beneficiaries aged ≥65 years hospitalized with TBI between 2006 and 2010 with continuous drug coverage for 12 months before and after TBI (N = 60,276)...
April 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28065636/neuroprotection-and-neurotoxicity-in-the-developing-brain-an-update-on-the-effects-of-dexmedetomidine-and-xenon
#19
Azeem Alam, Ka Chun Suen, Zac Hana, Robert D Sanders, Mervyn Maze, Daqing Ma
Growing and consistent preclinical evidence, combined with early clinical epidemiological observations, suggest potentially neurotoxic effects of commonly used anesthetic agents in the developing brain. This has prompted the FDA to issue a safety warning for all sedatives and anesthetics approved for use in children under three years of age. Recent studies have identified dexmedetomidine, the potent α2-adrenoceptor agonist, and xenon, the noble gas, as effective anesthetic adjuvants that are both less neurotoxic to the developing brain, and also possess neuroprotective properties in neonatal and other settings of acute ongoing neurologic injury...
January 6, 2017: Neurotoxicology and Teratology
https://www.readbyqxmd.com/read/28032265/using-continuous-quantitative-capnography-for-emergency-department-procedural-sedation-a-systematic-review-and-cost-effectiveness-analysis
#20
Nicholas Matthew Mohr, Andrew Stoltze, Azeemuddin Ahmed, Elizabeth Kiscaden, Dan Shane
End-tidal CO2 has been advocated to improve safety of emergency department (ED) procedural sedation by decreasing hypoxia and catastrophic outcomes. This study aimed to estimate the cost-effectiveness of routine use of continuous waveform quantitative end-tidal CO2 monitoring for ED procedural sedation in prevention of catastrophic events. Markov modeling was used to perform cost-effectiveness analysis to estimate societal costs per prevented catastrophic event (death or hypoxic brain injury) during routine ED procedural sedation...
December 28, 2016: Internal and Emergency Medicine
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