Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT

Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. Results: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Report Source Type: research

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Conclusion Slow decompression with closed-system drainage is recommended to avoid rapid dynamic intracranial changes during drainage of a subdural hematoma, including brain shift or restoration of normal perfusion,to prevent devastating complications.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Purpose of review To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. Recent findings Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsisten...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research
AbstractPurposeSurgery for aneurysmal clipping after subarachnoid haemorrhage (SAH) poses a unique anaesthetic challenge. However, data on the influence of anaesthetic agents in these patients are lacking. The study aims to evaluate the superiority of propofol over desflurane for postanaesthetic morbidity in patients undergoing surgery following aneurysmal SAH.MethodsSeventy World Federation of Neurosurgeons Grade I and II patients were  randomized into propofol (n = 35) and desflurane groups (n = 35). Anaesthesia was maintained with propofol/fentanyl in propofol group and desflurane/fentanyl in th...
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
DESPITE SIGNIFICANT IMPROVEMENTS in the management of patients with cardiovascular disease, stroke remains the second leading cause of death worldwide.1 Ischemic strokes account for 87% of all strokes, whereas 10% result from intracerebral hemorrhage, and 3% are subarachnoid hemorrhage strokes.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
We report the successful ECT treatment of depression in an older man who had developed a subarachnoid hemorrhage after a suicide attempt by ingestion of antifreeze.
Source: The Journal of ECT - Category: Psychiatry Tags: Case Reports Source Type: research
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Source: Anesthesiology - Category: Anesthesiology Source Type: research
Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enroll...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Report Source Type: research
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Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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Source: Interventional Neurology - Category: Neurology Source Type: research
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