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Brain injury sedation

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https://www.readbyqxmd.com/read/28725211/critical-evaluation-of-the-lund-concept-for-treatment-of-severe-traumatic-head-injury-25%C3%A2-years-after-its-introduction
#1
REVIEW
Per-Olof Grände
When introduced in 1992, the Lund concept (LC) was the first complete guideline for treatment of severe traumatic brain injury (s-TBI). It was a theoretical approach, based mainly on general physiological principles-i.e., of brain volume control and optimization of brain perfusion and oxygenation of the penumbra zone. The concept gave relatively strict outlines for cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The LC strives for treatment of the pathophysiological mechanisms behind symptoms rather than just treating the symptoms...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28712906/a-comparison-of-pharmacologic-therapeutic-agents-used-for-the-reduction-of-intracranial-pressure-following-traumatic-brain-injury
#2
REVIEW
Ahmed M Alnemari, Brianna M Krafcik, Tarek R Mansour, Daniel Gaudin
OBJECTIVE: In neurotrauma care, a better understanding of treatments following traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications following TBI are associated with the initial injury and post-event intracranial processes such as elevated intracranial pressure (ICP) and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion...
July 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28708753/effectiveness-of-preoperative-intranasal-dexmedetomidine-compared-with-oral-midazolam-for-the-prevention-of-emergence-delirium-in-the-pediatric-patient-undergoing-general-anesthesia-a-systematic-review
#3
James FitzSimons, Laura S Bonanno, Stephanie Pierce, Jennifer Badeaux
BACKGROUND: Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury...
July 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28667360/cortical-venous-disease-severity-in-melas-syndrome-correlates-with-brain-lesion-development
#4
M T Whitehead, M Wien, B Lee, N Bass, A Gropman
PURPOSE: MELAS syndrome is a mitochondrial disorder typified by recurrent stroke-like episodes, seizures, and progressive brain injury. Abnormal mitochondria have been found in arterial walls implicating a vasculogenic etiology. We have observed abnormal cortical vein T2/FLAIR signal in MELAS patients, potentially representing wall thickening and sluggish flow. We sought to examine the relationship of hyperintense veins and brain lesions in MELAS. METHODS: Imaging databases at two children's hospitals were searched for brain MRIs from MELAS patients...
June 30, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28655027/zolpidem-for-the-treatment-of-neurologic-disorders-a-systematic-review
#5
Martin N Bomalaski, Edward S Claflin, Whitney Townsend, Mark D Peterson
Importance: Given its selective action on the ω1 subtype of the γ-aminobutyric acid A receptor, zolpidem tartrate presents a potential treatment mechanism for other neurologic disorders. Objective: To synthesize studies that used zolpidem to treat neurologic disorders. Evidence Review: Eligibility criteria included any published English-language article that examined the use of zolpidem for noninsomnia neurologic disorders in humans for all dates up to March 20, 2015...
June 26, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28601747/road-traffic-crash-risk-associated-with-prescription-of-hydroxyzine-and-other-sedating-h1-antihistamines-a-responsibility-and-case-crossover-study
#6
Ludivine Orriols, Audrey Luxcey, Benjamin Contrand, Anne Bénard-Laribière, Antoine Pariente, Blandine Gadegbeku, Emmanuel Lagarde
BACKGROUND: H1 antihistamines differ from each other by their ability to cross the blood-brain barrier. The resulting sedating effect can be sought in therapy but may be a driving hazard. The aim of this study was to estimate the impact of sedating H1-antihistamines on the risk of road traffic crash, with a particular focus on hydroxyzine which is also indicated as an anxiolytic in France. METHODS: The study consisted in extracting and matching data from three French nationwide databases: the national healthcare insurance database, police reports and the police national database of injurious crashes...
June 8, 2017: Accident; Analysis and Prevention
https://www.readbyqxmd.com/read/28584438/neurogenic-pulmonary-edema-in-traumatic-brain-injury
#7
Ramanan Rajagopal, Swaminathan Ganesh, Muralidharan Vetrivel
A 29-year-old male admitted with severe traumatic brain injury following a road traffic accident was sedated and ventilated uneventfully for 72 h. On the fourth posttrauma day, after stopping sedation to assess readiness for extubation, he developed sudden onset desaturation; arterial blood gas showed severe diffusion defect with very low PaO2/FiO2 ratio following an episode of generalized tonic-clonic seizure. The differential diagnoses and further management are discussed.
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28570486/handheld-spectral-domain-optical-coherence-tomography-imaging-through-the-undilated-pupil-in-infants-born-preterm-or-with-hypoxic-injury-or-hydrocephalus
#8
Du Tran-Viet, Brittany M Wong, Shwetha Mangalesh, Ramiro Maldonado, C Michael Cotten, Cynthia A Toth
PURPOSE: The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities. METHODS: Under an institutional review board-approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities...
May 29, 2017: Retina
https://www.readbyqxmd.com/read/28536271/contrasting-modulatory-effects-from-the-dorsal-and-ventral-premotor-cortex-on-primary-motor-cortex-outputs
#9
Sandrine L Côté, Adjia Hamadjida, Stephan Quessy, Numa Dancause
The dorsal and ventral premotor cortices (PMd and PMv, respectively) each take part in unique aspects for the planning and execution of hand movements. These premotor areas are components of complex anatomical networks that include the primary motor cortex (M1) of both hemispheres. One way that PMd and PMv could play distinct roles in hand movements is by modulating the outputs of M1 differently. However, patterns of effects from PMd and PMv on the outputs of M1 have not been compared systematically. Our goals were to study how PMd within the same (i...
June 14, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
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
#10
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
#11
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
#12
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...
July 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#13
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
#14
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
#15
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
#16
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...
August 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
#17
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...
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
#18
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
#19
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
#20
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
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