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Brain injury sedation

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https://www.readbyqxmd.com/read/29149387/analgosedation-in-paediatric-severe-traumatic-brain-injury-tbi-practice-pitfalls-and-possibilities
#1
N Ketharanathan, Y Yamamoto, U Rohlwink, E D Wildschut, M Hunfeld, E C M de Lange, D Tibboel
Analgosedation is a fundamental part of traumatic brain injury (TBI) treatment guidelines, encompassing both first and second tier supportive strategies. Worldwide analgosedation practices continue to be heterogeneous due to the low level of evidence in treatment guidelines (level III) and the choice of analgosedative drugs is made by the treating clinician. Current practice is thus empirical and may result in unfavourable (often hemodynamic) side effects. This article presents an overview of current analgosedation practices in the paediatric intensive care unit (PICU) and addresses pitfalls both in the short and long term...
October 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29089921/the-neurological-wake-up-test-a-role-in-neurocritical-care-monitoring-of-traumatic-brain-injury-patients
#2
REVIEW
Niklas Marklund
The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29043546/compensatory-reserve-weighted-intracranial-pressure-and-its-association-with-outcome-after-traumatic-brain-injury
#3
L Calviello, J Donnelly, D Cardim, C Robba, F A Zeiler, P Smielewski, M Czosnyka
OBJECTIVE: We introduced 'compensatory-reserve-weighted intracranial pressure (ICP),' named 'weightedICP' for brevity, as a variable that may better describe changes leading to mortality after traumatic brain injury (TBI) over the standard mean ICP. METHODS: ICP was monitored prospectively in over 1023 sedated and ventilated patients. The RAP coefficient (R-correlation, A-amplitude, and P-pressure) was calculated as the running correlation coefficient between slow changes in the pulse amplitude of ICP and the mean ICP...
October 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29022129/the-utility-of-local-anesthesia-for-neurosurgical-interventions-in-a-low-resource-setting-a-case-series
#4
Jessica Eaton, Asma Bilal Hanif, Suzgisam Mzumara, Anthony Charles
INTRODUCTION: Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. METHOD: This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia...
October 11, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28993273/acute-mental-stress-induces-mitochondrial-bioenergetic-crisis-and-hyper-fission-along-with-aberrant-mitophagy-in-the-gut-mucosa-in-rodent-model-of-stress-related-mucosal-disease
#5
Rudranil De, Somnath Mazumder, Souvik Sarkar, Subhashis Debsharma, Asim Azhar Siddiqui, Shubhra Jyoti Saha, Chinmoy Banerjee, Shiladitya Nag, Debanjan Saha, Uday Bandyopadhyay
Psychological stress, depression and anxiety lead to multiple organ dysfunctions wherein stress-related mucosal disease (SRMD) is common to people experiencing stress and also occur as a side effect in patients admitted to intensive care units; however the underlying molecular aetiology is still obscure. We report that in rat-SRMD model, cold restraint-stress severely damaged gut mitochondrial functions to generate superoxide anion (O2(•-)), depleted ATP and shifted mitochondrial fission-fusion dynamics towards enhanced fission to induce mucosal injury...
October 7, 2017: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/28975867/the-pharmacogenomics-of-severe-traumatic-brain-injury
#6
Solomon M Adams, Yvette P Conley, Amy K Wagner, Ruchira M Jha, Robert Sb Clark, Samuel M Poloyac, Patrick M Kochanek, Philip E Empey
Pharmacotherapy for traumatic brain injury (TBI) is focused on resuscitation, prevention of secondary injury, rehabilitation and recovery. Pharmacogenomics may play a role in TBI for predicting therapies for sedation, analgesia, seizure prevention, intracranial pressure-directed therapy and neurobehavioral/psychiatric symptoms. Research into genetic predictors of outcomes and susceptibility to complications may also help clinicians to tailor therapeutics for high-risk individuals. Additionally, the expanding use of genomics in the drug development pipeline has provided insight to novel investigational and repurposed medications that may be useful in the treatment of TBI and its complications...
October 4, 2017: Pharmacogenomics
https://www.readbyqxmd.com/read/28970658/pain-measurement-in-mechanically-ventilated-patients-with-traumatic-brain-injury-behavioral-pain-tools-versus-analgesia-nociception-index
#7
Ali Jendoubi, Ahmed Abbes, Salma Ghedira, Mohamed Houissa
INTRODUCTION: Pain is highly prevalent in critically ill trauma patients, especially those with a traumatic brain injury (TBI). Behavioral pain tools such as the behavioral pain scale (BPS) and critical-care pain observation tool are recommended for sedated noncommunicative patients. Analysis of heart rate variability (HRV) is a noninvasive method to evaluate autonomic nervous system activity. The analgesia nociception index (ANI) device (Physiodoloris(®), MDoloris Medical Systems, Loos, France) allows noninvasive HRV analysis...
September 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28969317/dexmedetomidine-mediated-neuroprotection-against-sevoflurane-induced-neurotoxicity-extends-to-several-brain-regions-in-neonatal-rats
#8
J F Perez-Zoghbi, W Zhu, M R Grafe, A M Brambrink
Background: Exposure of infant animals to clinically used anaesthetics is associated with acute structural brain abnormalities and development functional alterations. The α 2 -adrenoceptor agonist dexmedetomidine (DEX) induces sedation, analgesia, and provides neuroprotection in experimental brain injury models. However, it is unknown whether DEX also affords protection in the developing brain against anaesthesia using sevoflurane (SEVO), which is commonly used in paediatric anaesthesia...
September 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28969315/alternative-technique-or-mitigating-strategy-for-sevoflurane-induced-neurodegeneration-a-randomized-controlled-dose-escalation-study-of-dexmedetomidine-in-neonatal-rats
#9
J-R Lee, E P Lin, R D Hofacer, B Upton, S Y Lee, L Ewing, B Joseph, A W Loepke
Background: Brain injury in newborn animals from prolonged anaesthetic exposure has raised concerns for millions of children undergoing anaesthesia every yr. Alternative anaesthetic techniques or mitigating strategies are urgently needed to ameliorate potentially harmful effects. We tested dexmedetomidine, both as a single agent alternative technique and as a mitigating adjuvant for sevoflurane anaesthesia. Methods: Neonatal rats were randomized to three injections of dexmedetomidine (5, 25, 50, or 100 µg kg -1 every 2 h), or 6 h of 2...
September 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28969310/what-do-recent-human-studies-tell-us-about-the-association-between-anaesthesia-in-young-children-and-neurodevelopmental-outcomes
#10
J D O'Leary, D O Warner
Anaesthetic and sedative drugs transiently disrupt normal neural activity to facilitate healthcare procedures in children, but they can also cause long-term brain injury in experimental animal models. The US Food and Drug Administration (FDA) has recently advised that repeated or lengthy exposures to anaesthetic and sedative drugs prior to 3 yr of age have the potential to harm the development of children's brains and added warnings to these drug labels. Paediatric anaesthesia toxicity could represent a significant public health issue, and concern about this potential injury in children has become an important issue for families, paediatric clinicians and healthcare regulators...
September 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28963716/the-monoacylglycerol-lipase-inhibitor-kml29-with-gabapentin-synergistically-produces-analgesia-in-mice
#11
Molly S Crowe, Catheryn D Wilson, Emma Leishman, Paul L Prather, Heather B Bradshaw, Matthew L Banks, Steven G Kinsey
BACKGROUND AND PURPOSE: Gabapentin (GBP) is commonly prescribed for nerve pain but may also cause dizziness, sedation, and gait disturbances. Similarly, inhibition of the endogenous cannabinoid enzyme monoacylglycerol lipase (MAGL) has antinociceptive and anti-inflammatory properties, but also induces sedation in mice at high doses. To limit these side effects, the present study investigated the analgesic effects of coadministering a MAGL inhibitor with GBP. EXPERIMENTAL APPROACH: Mice subjected to the chronic constriction injury (CCI) model of neuropathic pain were administered the MAGL inhibitor KML29 (1-40 mg kg(-1) , i...
September 29, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28962805/management-of-traumatic-brain-injury-an-update
#12
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...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28935558/immediate-interruption-of-sedation-compared-with-usual-sedation-care-in-critically-ill-postoperative-patients-sos-ventilation-a-randomised-parallel-group-clinical-trial
#13
Gerald Chanques, Matthieu Conseil, Claire Roger, Jean-Michel Constantin, Albert Prades, Julie Carr, Laurent Muller, Boris Jung, Fouad Belafia, Moussa Cissé, Jean-Marc Delay, Audrey de Jong, Jean-Yves Lefrant, Emmanuel Futier, Grégoire Mercier, Nicolas Molinari, Samir Jaber
BACKGROUND: Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes. METHODS: We did a randomised, parallel-group, clinical trial at three ICUs in France. Stratified randomisation with minimisation (1:1 via a restricted web platform) was used to assign eligible patients (aged ≥18 years, admitted to an ICU after abdominal surgery, and expected to require at least 12 h of mechanical ventilation because of a critical illness defined by a Sequential Organ Failure Assessment score >1 for any organ, but without severe acute respiratory distress syndrome or brain injury) to usual sedation care provided according to recommended practices (control group) or to immediate interruption of sedation (intervention group)...
October 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28931374/effects-of-dexmedetomidine-on-tnf-%C3%AE-and-interleukin-2-in-serum-of-rats-with-severe-craniocerebral-injury
#14
Wan-Wei Jiang, Qing-Hui Wang, Ya-Jing Liao, Pai Peng, Min Xu, Li-Xin Yin
BACKGROUND: Dexmedetomidine is a highly selective adrenergic receptor agonist, which has a dose-dependent sedative hypnotic effect. Furthermore, it also has pharmacological properties, and the ability to inhibit sympathetic activity and improve cardiovascular stability during an operation. However, its protective effect on patients with severe craniocerebral injury in the perioperative period remains unclear. METHOD: Eighty adult male SD rats were used and divided into two groups (n = 40, each group): dexmedetomidine injury group (experimental group), and sodium chloride injury group (control group)...
September 20, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28856464/dosage-of-methylphenidate-and-traumatic-brain-injury-in-adhd-a-population-based-study-in-taiwan
#15
Yin-To Liao, Yao-Hsu Yang, Ting-Yu Kuo, Hsin-Yi Liang, Kuo-You Huang, Tsu-Nai Wang, Yena Lee, Roger S McIntyre, Vincent Chin-Hung Chen
Preventive effect of stimulants on the risk of brain injuries had been reported. The aim of this study is to determine the extent to which methylphenidate (MPH) prescription moderates the risk of traumatic brain injuries (TBI) in individuals with attention-deficit/hyperactivity disorder (ADHD). Individuals with a recent diagnosis of ADHD between January 1997 and December 2013 (n = 163,618) were identified from Taiwan's National Health Insurance Research Database. A total of 124,438 adolescents and children with ADHD and without prior TBI diagnoses were included and evaluated for subsequent TBI...
August 30, 2017: European Child & Adolescent Psychiatry
https://www.readbyqxmd.com/read/28831717/a-randomized-trial-of-brief-versus-extended-seizure-prophylaxis-after-aneurysmal-subarachnoid-hemorrhage
#16
Theresa Human, Michael N Diringer, Michelle Allen, Gregory J Zipfel, Michael Chicoine, Ralph Dacey, Rajat Dhar
BACKGROUND: Seizures occur in 10-20% of patients with subarachnoid hemorrhage (SAH), predominantly in the acute phase. However, anticonvulsant prophylaxis remains controversial, with studies suggesting a brief course may be adequate and longer exposure may be associated with worse outcomes. Nonetheless, in the absence of controlled trials to inform practice, patients continue to receive variable chemoprophylaxis. The objective of this study was to compare brief versus extended seizure prophylaxis after aneurysmal SAH...
August 22, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28816834/effect-of-amantadine-on-agitation-in-critically-ill-patients-with-traumatic-brain-injury
#17
Jawaher A Gramish, Brian J Kopp, Asad E Patanwala
OBJECTIVE: This study aimed to compare the presence of agitation in traumatic brain injury patients treated with amantadine with those not treated with amantadine in the intensive care unit (ICU). METHODS: This was a retrospective cohort study conduced in a trauma ICU of a tertiary care institution in the United States. Patients who received amantadine were compared with patients who did not receive amantadine. The primary outcome measure was the presence of agitation, defined as the Richmond Agitation Sedation Scale score of +2 or higher...
September 2017: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/28774294/temperature-variability-in-the-day-night-cycle-is-associated-with-further-intracranial-pressure-during-therapeutic-hypothermia
#18
Adriano Barreto Nogueira, Eva Annen, Oliver Boss, Faraneh Farokhzad, Christopher Sikorski, Emanuela Keller
BACKGROUND: To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia. METHODS: We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24). RESULTS: We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm...
August 3, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28759530/sevoflurane-attenuates-systemic-inflammation-compared-with-propofol-but-does-not-modulate-neuro-inflammation-a-laboratory-rat-study
#19
Beatrice Beck-Schimmer, Lukas Baumann, Tanja Restin, Philipp Eugster, Melanie Hasler, Christa Booy, Martin Schläpfer
BACKGROUND: Septic encephalopathy is believed to be a result of neuro-inflammation possibly triggered by endotoxins, such as lipopolysaccharides (LPS). Modulation of the immune system is a property of volatile anaesthetics. OBJECTIVE: We aimed to investigate the systemic and cerebral inflammatory response in a LPS-induced sepsis model in rats. We compared two different sedation strategies, intravenous propofol and the volatile anaesthetic sevoflurane, with the hypothesis that the latter may attenuate neuro-inflammatory processes...
July 28, 2017: European Journal of Anaesthesiology
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
#20
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
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