Abstract
Background
Physical therapist intervention can play a significant role in the prevention of mechanical and infectious complications in patients with traumatic brain injury (TBI) who are ...mechanically ventilated.
Objective
The objective of this study was to observe and compare the effects of manual and mechanical airway clearance techniques on intracranial pressure (ICP) and hemodynamics in patients with severe TBI.
Design
The design was a prospective, randomized, crossover trial.
Setting
The setting was a neurointensive care unit at a level 1 trauma center.
Patients
Forty-six adult patients aged 18 to 75 years, of either sex, with severe TBI, receiving mechanical ventilatory support with continuous ICP monitoring, and undergoing regular airway clearance techniques participated in this study.
Intervention
Two techniques were performed by a single trained physical therapist. Treatment A was a manual chest percussion technique and treatment B used a mechanical chest wall vibrator. Each treatment was applied for 10 minutes alternately, separated by an interval of 4 hours.
Measurements
ICP was measured from the start of intervention to 10 minutes postintervention. Secondary measurements included cerebral perfusion pressure, heart rate, mean arterial pressure (each from the start of the intervention until 10 minutes postintervention at 1-minute intervals), and arterial blood gas parameters (from just before the start of the intervention and 10 minutes postintervention).
Results
The increases in mean (95% CI) intracranial pressure of 2.4 (1.4–3.4) and 1.0 (0.2–1.8) mmHg, during and after the intervention with treatment A, respectively, were statistically significantly higher than for treatment B, irrespective of sequence. In contrast, a mean heart rate rise of 6.4 (3.3–9.5) beats/min and mean arterial pressure rise of 5.3 (2.0–8.6) mmHg were significantly higher only during the intervention phase of treatment A compared with treatment B. Peak mean values of ICP, heart rate, and arterial pressure were also significantly higher during treatment A. However, mean values of cerebral perfusion pressure or its degree of change were statistically comparable in both treatment groups.
Limitations
Patients with high baseline ICP values (>20 mmHg) were excluded, and, because of the crossover design, the effect of individual technique on final (long-term) neurological or respiratory outcomes could not be studied.
Conclusion
Manual chest percussion technique in patients with severe TBI was associated with statistically significant transient increases in ICP and hemodynamics, compared with the mechanical method. However, such transient increases in ICP by either technique were not clinically relevant in patients with moderate-to-severe TBI without intracranial hypertension on a mechanical ventilator.
Background
Perioperative pain assessment and management in neurosurgical patients varies widely across the globe. There is lack of data from developing world regarding practices of pain assessment ...and management in neurosurgical population. This survey aimed to capture practices and perceptions regarding perioperative pain assessment and management in neurosurgical patients among anesthesiologists who are members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) and evaluated if hospital and pain characteristics predicted the use of structured pain assessment protocol and use of opioids for postoperative pain management.
Methods
A 26‐item English language questionnaire was administered to members of ISNACC using Kwiksurveys platform after ethics committee approval. Our outcome measures were adoption of structured protocol for pain assessment and opioid usage for postoperative pain management.
Results
The response rate for our survey was 55.15% (289/524). One hundred eighteen (41%) responders informed that their hospital setup had a structured pain protocol while 43 (15%) responders reported using opioids for postoperative pain management. Predictors of the use of structured pain protocol were private setup (odds ratio OR 2.64; 95% confidence interval CI 1.52‐4.59; P = .001), higher pain intensity (OR 0.37; 95% CI 0.21‐0.64; P < .001) and use of pain scale (OR 7.94; 95% CI 3.99‐15.81; P < .001) while availability of structured pain protocol (OR 2.04; 95% CI 1.02‐4.05; P = .043) was the only significant variable for postoperative opioid use.
Conclusions
Less than half of the Indian neuroanesthesiologists who are members of ISNACC use structured protocol for pain assessment and very few use opioids for postoperative pain management in neurosurgical patients.
The clinical diagnosis of traumatic brain injury (TBI) is based on neurological examination and neuro-imaging tools such as CT scanning and MRI. However, neurological examination at times may be ...confounded by consumption of alcohol or drugs and neuroimaging facilities may not be available at all centers. Human ubiquitin C-terminal hydrolase (UCHL1) is a well-accepted serum biomarker for severe TBI and can be used to detect the severity of a head injury. A reliable, rapid, cost effective, bedside and easy to perform method for the detection of UCHL1 is a pre-requisite for wide clinical applications of UCHL1 as a TBI biomarker. We developed a rapid detection method for UCHL1 using surface plasmon resonance of gold nanoparticles with a limit of detection (LOD) of 0.5 ng mL-1. It has a sensitivity and specificity of 100% each and meets an analytical precision similar to that of conventional sandwich ELISA but can be performed rapidly. Using this method we successfully detected UCHL1 in a cohort of 66 patients with TBI and were reliably able to distinguish mild TBI from moderate to severe TBI.
Background and Aims: Posterior vessel wall puncture (PVWP) is a common complication of ultrasound (US) guided central venous cannulation. We evaluated and compared the frequency of PWVP of internal ...jugular vein using short axis (SA) and long axis (LA) approach of US-guided needle cannulation. As a secondary objective incidence of carotid puncture was assessed.
Material and Methods: Prospective, single-blinded, cross over, observational study at Urban Level I Neuroanesthesiology and Critical Care Department. Residents receiving standard education on ultrasound-guided central venous cannulation were asked to place an US-guided catheter using either short axis or long axis approach on a human torso mannequin. During the procedure, the path of the needle was carefully observed by the investigator for any PVWP and carotid puncture without interference with the placement procedure. The confidence level of the resident for the intraluminal placement of the needle tip was measured on a 10-point Likert scale.
Results: Forty residents participated in the study. The incidence of PVWP in SA and LA group was 40% and 17.5% respectively and was statistically significant (p = 0.026). There was no incidence of carotid artery puncture in either of the group. The mean confidence of intraluminal placement of needle was significantly higher in the LA group (8.32) as compared to the SA group (5.95).
Conclusion: Lower incidence of PVWP was seen in LA as compared to the SA approach during US-guided IJV cannulation in phantom in residents having previous experience of CVC (central venous cannulation) in landmark technique only. Participants were more confident about intraluminal needle placement in the LA group compared to the SA group.
The pathogenesis of idiopathic intracranial hypertension (IIH) is currently poorly understood. This exploratory study aimed to identify potential cerebrospinal fluid (CSF) biomarkers in IIH cases ...compared to controls using SWATH-MS proteomics approach.
CSF samples were collected prospectively from IIH cases and control subjects which were subjected to SWATH-MS based untargeted proteomics. Proteins with fold change > 1.5 or < 0.67 and p-value < 0.05 were considered significantly differentially expressed. Data are available via ProteomeXchange with identifier PXD027751. Statistical analysis was conducted in R version 3.6.2.
We included CSF samples from 33 subjects, consisting of 13 IIH cases and 20 controls. A total of 262 proteins were identified in Proteinpilot search. Through SWATH analysis, we quantified 232 proteins. We observed 37 differentially expressed proteins between the two groups with 24 upregulated and 13 downregulated proteins. There were two differential proteins among overweight versus non-overweight IIH cases. Network for 23 proteins was highly connected in the interaction analysis.
Neurosecretory, neuroendocrine, and inflammatory proteins were predominantly involved in causing IIH. This exploratory study served as a platform to identify 37 differentially expressed proteins in IIH and also showed significant differences between overweight and non-overweight IIH patients.
The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. A significant number of these patients would present to hospitals with neurological manifestations and neurosurgical ...emergencies requiring urgent treatment. The anesthesiologists should be prepared to manage these cases in an efficient and timely manner in the operating room, intensive care units, and interventional neuroradiology suites. The clinical course of the disease is in an evolving stage. As we acquire more knowledge about COVID-19, new recommendations and guidelines are being formulated and regularly updated. This article discusses the anesthetic management of urgent neurosurgical and neurointerventional procedures. In addition, a brief overview of intrahospital transport of neurologically injured patients has been addressed.
Severe brain swelling during routine neurosurgery can herald serious consequences. Failure to control brain swelling despite adequate measures warns of a surgical cause and should be dealt ...efficiently. We report a case of an adult female who developed intraoperative acute subdural haematoma (SDH) and consequent intractable brain swelling during surgery of supratentorial arteriovenous malformation (AVM). Such a manifestation of contralateral acute SDH during supratentorial AVM surgery has not been reported earlier.
A 25-year-male patient presented to us in the pre-operative assessment clinic with the complaints of continuous irritation in throat and repeated episodes of nausea and vomiting. Endovascular ...treatment by coiling of dissecting pseudoaneurysm was done and complete occlusion was achieved. 4 Potential complications of coiling include thrombosis, stenosis, and less commonly, coil extrusion due to continuous forces pressing opposite the thin pseudoaneurysm capsule.
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