The year in review – neuroanaesthesia and neurointensive care

Česká verzia

Authors: V. Dostálová; P. Dostál
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova
Published in the journal: Anest. intenziv. Med., 30, 2019, č. 6, s. 265-270
Category:

Summary

The development of surgical techniques requires the introduction of new anaesthetic approaches. In neuroanesthesia, the emphasis is placed on the so-called multimodal approach to conducting anesthesia. The use of Dexmedetomidine allows us to extend the indications for resection of tumours in the eloquent areas as well as to patients with expected difficult airway management, especially during reintubation in the last phase of surgery. Also, reduction in the incidence and severity of delirant conditions in the phase of awakening during surgery is possible by replacing general anesthesia with sedation using Dexmedetomidine. We comment on the results of the first prospective study on the safety of head elevation with regard to the incidence and severity of venous air embolism, and studies comparing general anesthesia vs. sedation in patients with ischaemic stroke (results of subgroup analysis of DEFUSE 3).

From the realm of neurointensive care, we present the results of a study examining the effect of tranexamic acid on the extent and clinical outcomes of patients with spontaneous intracerebral hemorrhage (CRASH-3 study), the effects of introduction of the so-called minimal invasive intervention in spontaneous intracerebral hemorrhage (MISTIE 3 study) and transfusion safety study in severe brain injury (TRAHT study). Last but not least, we have introduced new recommendations in the care of severe brain injuries in adults (SIBICC).

Keywords:

anaesthesia – neurosurgery – intensive care – literature in medicine

Zdroje

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14. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32.

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17. The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet. 2019,October 14, doi: https://doi.org/10.1016/S0140-6736(19)32233-0.

18. Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial for the TICH-2. Lancet. 2018; 391:2107–2115.

19. Sarma AK, Ghoshal S, Craven SJ, Sarwal A. Intracerebral Hemorrhage: A Brief Evidence-Based Review of Common Etiologies, Mechanisms of Secondary Injury, and Medical and Surgical Management. J Neuroanaesthesiol Crit Care. 2019,6:119–130.

20. Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet. 2019 Mar 9;393:1021–1032. Erratum in: Lancet. 2019;393:1596.

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22. Leal-Noval SR, Rincón-Ferrari MD, Múñoz-Gómez M. Red blood cell transfusion may be more detrimental than anemia for the clinical outcome of patients with severe traumatic brain injury. Crit Care. 2019;23:189.

23. Leal-Noval SR, Arellano-Orden V, Muñoz-Gómez M, et al. Red blood cell transfusion guided by near infrared spectroscopy in neurocritically ill patients with moderate or severe anemia: A randomized, controlled trial. J Neurotrauma. 2017;34:2553–2559.

24. Leal-Noval SR, Muñoz-Serrano Á, Arellano-Orden V, et al. Effects of red blood cell transfusion on long-term disability of patients with traumatic brain injury. Neurocrit Care. 2016;24:371–380.

25. Gobatto ALN, Link MA, Solla DJ, et al. Transfusion requirements after head trauma: a randomized feasibility controlled trial. Crit Care. 2019;23:89.

26. Hawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019 Oct 28. doi: 10.1007/s00134-019-05805-9.