Anesthetic Care for the Post-concussive Patient: There Are More Questions Than Answers

AbstractPurpose of ReviewThis review informs the practicing clinician regarding the pathophysiology of mild traumatic brain injury and its implication on the anesthetic management of patients presenting for surgery. It highlights several areas where data is sparse that might spark the interest of researchers. It proposes a broad guideline for managing patients who present for surgery.Recent FindingsThe post-concussive brain has a vulnerable window of risk in which secondary insult might worsen long-term outcome. Scheduling elective surgery beyond this window of vulnerability might be beneficial. Several biomarkers may prove to be helpful in determining the timing of elective surgery and in risk stratification for the patient undergoing urgent or emergent surgery.SummaryMild traumatic brain injury is common. Patients often present in the acute care setting for surgical procedures unrelated to their head injury. The care of these patients may influence the natural history of their intracranial pathology and may impact long-term outcomes. In this review, we provide a brief synopsis of the pathophysiology of this disease. We discuss potential anesthetic interactions, offer broad guidelines for anesthetic management based on available data, and suggest areas of future research.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research

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The clinical use of vasoactive drugs aims to improve hemodynamic variables and thereby maintain or restore adequate perfusion and oxygenation in accordance with metabolic demands. A main focus in the management of patients with brain pathology during surgery and neurointensive care is restoring and/or maintaining adequate cerebral perfusion pressure in order to ensure cerebral blood flow in accordance with metabolic demands. One commonly used clinical strategy is the administration of vasoactive drugs aiming to increase mean arterial blood pressure and thereby cerebral perfusion pressure. Here, we first describe the anatom...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Review Articles Source Type: research
Several lines of evidences show that anesthetics influence neurotoxicity and neuroprotection. The possibility that different anesthetic agents potentially influence the pathophysiological and functional outcome following neurotrauma was examined in a rat m...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Economics of Injury and Safety, PTSD, Injury Outcomes Source Type: news
Publication date: 2019Source: International Review of Neurobiology, Volume 146Author(s): Hari Shanker Sharma, Dafin Fior Muresanu, Ala Nozari, Rudy J. Castellani, Prasanta Kumar Dey, Lars Wiklund, Aruna SharmaAbstractSeveral lines of evidences show that anesthetics influence neurotoxicity and neuroprotection. The possibility that different anesthetic agents potentially influence the pathophysiological and functional outcome following neurotrauma was examined in a rat model of concussive head injury (CHI). The CHI was produced by an impact of 0.224 N on the right parietal bone by dropping a weight of 114.6 g from ...
Source: International Review of Neurobiology - Category: Neuroscience Source Type: research
Publication date: Available online 8 July 2019Source: International Review of NeurobiologyAuthor(s): Hari S. Sharma, Dafin F. Muresanu, Ala Nozari, Rudy J. Castellani, Prasanta K. Dey, Lars Wiklund, Aruna SharmaAbstractSeveral lines of evidences show that anesthetics influence neurotoxicity and neuroprotection. The possibility that different anesthetic agents potentially influence the pathophysiological and functional outcome following neurotrauma was examined in a rat model of concussive head injury (CHI). The CHI was produced by an impact of 0.224 N on the right parietal bone by dropping a weight of 114.6 g fro...
Source: International Review of Neurobiology - Category: Neuroscience Source Type: research
Fernando Zanela Areas1,2, Marcelo Liborio Schwarzbold1,2,3,4, Alexandre Paim Diaz1,4, Igor Kunze Rodrigues3,5,6, Daniel Santos Sousa3,7, Camila Leite Ferreira8, João Quevedo8,9, Katia Lin1,3,10, Emil Kupek3,11, Cristiane Ritter12,13, Felipe Dal Pizzol3,12,13 and Roger Walz1,2,3,10* 1Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil 2Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, Brazil 3Programa de Pós-Graduação em Ciências Médicas, ...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We report a case of a 13-year-old girl with HGPS who presented with an extradural haematoma following head injury. A conservative approach was successfully employed in this case, avoiding the risks of general anaesthesia and surgery.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
Traumatic brain injury (TBI) results in systemic changes in coagulation and inflammation that contribute to post-traumatic morbidity and mortality. The potential interaction of platelets and pro-inflammatory cytokines in the modulation of coagulation, microthrombosis, and venous thromboembolic events after moderate TBI has not been determined. Using a murine model, we hypothesized that the degree of platelet-induced coagulation varies depending on the platelet aggregation agonist platelet-induced coagulation changes in a time-dependent manner following TBI, and changes in platelet-induced coagulation are mirrored by change...
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Conclusions Ketamine alters hippocampal cell proliferation after traumatic brain injury. Surprisingly, these changes were associated with improvement in a neurogenesis-related behavioral recall task, suggesting a possible benefit from ketamine administration after traumatic brain injury in mice. Future studies are needed to determine generalizability and mechanism.
Source: Anesthesiology - Category: Anesthesiology Source Type: research
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