Neuromonitoring

Publication date: Available online 7 April 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Malcolm E. Smith, Martin Smith Management of acute brain injury is based on a central concept that prevention of secondary hypoxic/ischaemic injury is associated with improved outcomes. While clinical assessment of neurological state remains fundamental to neuromonitoring, several techniques are available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality monitoring have enabled an individually tailored approach to patient management in which treatment decisions are guided by monitored changes in physiological variables rather than pre-defined, generic thresholds. Any impact of monitor-guided therapy on outcomes is entirely dependent on the threshold to initiative intervention and subsequent management in response to change in a particular monitored variable, and these remain undefined in many circumstances. This review describes current neuromonitoring techniques used during the critical care management of acute brain injury.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research

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Acute Kidney Injury (AKI) is an important complication after cardiac surgery and increases the morbidity and mortality of patients while increasing health care costs.1 AKI occurs in up to 30% of patients undergoing cardiac surgery, and dialysis is necessary in 1% to 2%.2 Preoperative risk factors for AKI in these patients include age, diabetes, anemia, renal insufficiency, contrast exposure, atrial fibrillation, and lower ejection fraction. Intraoperative factors include cardiopulmonary bypass (CPB) time, nonpulsatile flow, lowest hematocrit on pump, renal perfusion pressure, inflammatory response, and blood transfusion.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
This article is protected by copyright. All rights reserved. PMID: 31437328 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
e;k F Abstract BACKGROUND: The ability of inotropic agents to alter airway reactivity and lung tissue mechanics has not been compared in a well-controlled experimental model. Therefore, we compared the potential to alter lung tissue viscoelasticity and bronchodilator effects of commonly used inotropic agents in an isolated perfused rat lung model. METHODS: After achieving steady state lung perfusion, sustained bronchoconstriction was induced by acetylcholine (ACh). Isolated rat lungs were then randomly allocated to 6 groups treated with either saline vehicle (n = 8) or incremental concentrations of inotropes ...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Publication date: Available online 22 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Christian Schmidt, Astrid Ellen Berggreen, Matthias HeringlakeThe clinical usefulness of the so-called “static” cardiac filling pressures - central (CVP) and pulmonary-artery-occlusion-pressure (PAOP) – has come into question for guiding hemodynamic therapy due to their poor ability to predict fluid responsiveness in comparison with other monitoring modalities such as transpulmonary thermodilution-derived volumetric measurements, dynamic variables for assessing fluid responsiveness, and th...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
Abstract Effective blood management during cardiac surgery requires a multifactorial effort to limit exposure to allogeneic blood products. The present study evaluated the distribution of intraoperative interventions in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Records from patients undergoing non-reoperative surgery at 120 hospitals between January 2017 and December 2017 were reviewed, and red blood cell transfusion quartiles established. The 31 hospitals with the lowest transfusion rates fell into the first quartile (low transfusion group, n = 3,186 patients), while 29...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
ns SR Abstract KEY POINTS: Imaging techniques such as contrast echocardiography suggest that anatomic intra-pulmonary arteriovenous anastomoses (IPAVAs) are present at rest and are recruited to a greater extent in conditions such as exercise. IPAVAs have the potential to act as a shunt, however, gas exchange methods have not demonstrated significant shunt in the normal lung. To evaluate this discrepancy, we compared anatomic shunt with 25-µm microspheres to contrast echocardiography, and gas exchange shunt measured by the multiple inert gas elimination technique (MIGET). Intra-pulmonary shunt measured by 25-...
Source: The Journal of Physiology - Category: Physiology Authors: Tags: J Physiol Source Type: research
Editor ’s PerspectiveWhat We Already Know about This TopicCardiac output is an independent regulator of cerebral blood flow in healthy awake humansThe relationship between cardiac output and cerebral blood flow in anesthetized patients undergoing laparoscopy has not been previously characterizedWhat This Article Tells Us That Is NewAt steady-state depth of anesthesia, in patients undergoing laparoscopic cholecystectomy, creation of pneumoperitoneum decreased cardiac output and internal carotid artery blood flow while mean arterial pressure and end-tidal carbon dioxide levels remained unchangedBackground Little is kno...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Abstract The depth of anesthesia is commonly assessed in clinical practice by the patient's clinical signs. However, during cardiopulmonary bypass and hypothermia, common symptoms of nociception such as tachycardia, hypertension, sweating, or movement have low sensitivity and specificity in the description of the patient nociception and hypnosis, in particular, detecting nociceptive stimuli. Better monitoring of the depth of analgesia during hypothermia under cardiopulmonary bypass will avoid underdosage or overdosage of analgesia, especially opioids. Induced hypothermia has a multifactorial effect on the level of...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
CARDIOGENIC SHOCK is a state of inadequate end-organ perfusion resulting from myriad causes, including ischemia, myocarditis, acute and chronic heart failure, postcardiotomy, and post-transplantation. It is the leading cause of death among patients experiencing acute myocardial infarction, with a mortality of 40% to 50%.1 Treatment generally includes revascularization for ischemia and supportive care with inotropes, vasopressors, and fluids as needed. Refractory cardiogenic shock is defined as ongoing hypoperfusion despite the administration of multiple vasoactive medications and treatment of the underlying cause.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Pro and Con Source Type: research
We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research
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