61 research outputs found
Intravenous lidocaine in the management of severe brain tumor-associated headache
No full textThe incidence of headaches in the patients with intracranial neo plasms varies from 33 to 71% [1]. The patients may present with
symptoms that mimic a migraine, tension-type or a cluster headache
[2]. The pain may be deep aching, intermittent and non-throbbing in
quality, accompanied by nausea and vomiting which may occur in up to
36% of the patients [3]
Reply to Farahani, P.; Wahid, L. Comment on “Viderman et al. Remote Monitoring of Chronic Critically Ill Patients after Hospital Discharge: A Systematic Review. J. Clin. Med. 2022, 11, 1010”
No full textThank you very much for taking the time to read this systematic review and for sharing your thoughts [...
Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: A meta-analysis
No full textBackground: Awake craniotomy (AC) is the preferred option for the resection of tumors adjacent to eloquent cortical areas and in cases of intractable epilepsy. It is mostly used to maintain the integrity of the brain during intracranial neurosurgical procedures. Awake craniotomy requires the use of ideal anesthetics, hypnotics, and analgesics to balance sedation, prompt the reversal of sedation, and prevent respiratory depression while maintaining communication between patient and medical team. Although a wide variety of anesthetics and hypnotics have been used for awake craniotomy over the past several decades, the optimal drug for the procedure has yet to be determined. The purpose of this meta-analysis was to compare dexmedetomidine and propofol in terms of intraoperative adverse events (i.e., hypertension, hypotension, nausea, vomiting, respiratory depression), patient and surgeon satisfaction, and procedure duration. Methods: We searched PubMed, Google Scholar, and the Cochrane Library for relevant articles published between the inception of these databases and April of 2022. The systematic search yielded 781 articles. After screening, we excluded 778 articles. The remaining three articles reporting 138 patients were selected for meta-analysis. Results: This meta-analysis showed no statistically significant difference between propofol and dexmedetomidine related to intraoperative adverse events, patient satisfaction, or procedure duration. The only statistically significant result was surgeon satisfaction, which appeared to be higher in the dexmedetomidine group. Conclusions: Further high-quality randomized and controlled trials are needed to find a preferred agent for intraoperative sedation in awake craniotomy
Hemofiltration for neuroprotection in acute ischemic stroke: A prospective, pilot study
No full textBackground: Hemofiltration reduces blood levels of cytokines, glutamate, and other substances that increase the risk of stroke-associated neurodegeneration. This study aimed to assess the safety and efficacy of hemofiltration in acute ischemic stroke patients. Methods: A total of 37 patients (mean age 56 ± 16 years) who had an ischemic stroke within the previous 12 hours were randomized to receive hemofiltration for 36 hours (n = 19) or standard treatment (n = 18). The primary outcome of interest was the occurrence of adverse events during the 28-day period following the stroke symptom onset. The secondary outcome was to assess the efficacy of hemofiltration in acute ischemic stroke. Results: Eighteen patients who received hemofiltration and 17 patients who received standard care completed the study. There were no cases of sepsis or infection at the hemofiltration cannula site, nor other hemofiltration-related complications. There was one case of fatal hemorrhagic transformation in each of the two groups. We failed to find any favorable effects on NIHSS scores at 7 days. However, we observed 17 patients (94%) with systemic inflammatory response syndrome in the control group and only 13 (68%) in the hemofiltration group. Conclusion: Hemofiltration appears to be safe in acute ischemic stroke patients, but we were unable to demonstrate its efficacy. However, for a definite conclusion on efficacy, a larger study with longer follow-up is required
Ropivacaine withdrawal syndrome: a case report
No full textINTRODUCTION AND OBJECTIVES: Ropivacaine is a long-acting local anesthetic that causes prolonged anesthesia and is beneficial for a wide variety of surgeries. Systemic toxicity has been reported after usage of high dose ropivacaine or inadvertent intravascular administration. We report a case of ropivacaine withdrawal, which to our knowledge has not been previously described in the literature. CASE REPORT: The patient presented to our department with uncontrolled belt-like upper-abdominal pain, self-rated as a 9/10 on the numeric rating scale. We decided to use continuous epidural analgesia with ropivacaine through a multi-port epidural catheter. Pain was well controlled for one month without significant adverse effects. However, ropivacaine unexpectedly ran out and two hours later the patient developed agitation, generalized tremor, tachycardia, and tachypnea. These symptoms resolved 30 minutes after reinitiating epidural ropivacaine. DISCUSSION: Our hypothesis of ropivacaine withdrawal was related to the timing of symptoms in relation to drug administration over two episodes. The possible mechanism of the observed withdrawal syndrome is upregulation of voltage-gated sodium channels after prolonged inhibition, resulting in increase in sodium influx and genetic variation
Risk Factors and Mechanisms of Postoperative Delirium After Intracranial Neurosurgical Procedures
No full text: Postoperative delirium (POD) is a condition characterized by cerebral dysfunction or failure and associated with high morbidity and mortality, prolonged intensive care unit and hospital stay, increased costs and long-term disability. The risk factors can be divided into three categories: preoperative, intraoperative, and postoperative. POD is underrecognized, underdiagnosed, and undertreated condition which can lead to potentially life-threatening conditions. Prevention and treatment of POD include adequate perioperative pain control, maintenance of optimal blood pressure, water-electrolyte balance, hypoglycemia, hyperglycemia, sleep hygiene. Despite POD has been extensively studied in various types of surgery, there is not enough evidence on POD in intracranial neurosurgery. Patients undergoing open craniotomy might be at particular risk because on top of the above-mentioned factors, they also can have a direct neurosurgical brain injury. Future research on the POD in neurosurgical patients after intracranial interventions is needed. A bibliographic search was performed in the MEDLINE and PubMed virtual library. The following descriptors were used: POD, neurosurgery, anesthesia and POD, postoperative pain management and POD, water and electrolyte imbalance and POD, neurochemistry of POD. We included in this review original and review articles in the English language. Majority of non-neurosurgical patients have multiple risk factors for POD (preoperative, intraoperative, and postoperative); patients undergoing intracranial neurosurgery might have additional risks associated with neurosurgical pathology (brain tumor, cerebral hemorrhage, and severe traumatic brain injury) as well as neurosurgery-induced brain injury can also appear to be a contributing factor
Artificial Intelligence in Resuscitation: A Scoping Review
No full textIntroduction: Cardiac arrest is a significant cause of premature mortality and severe disability. Despite the death rate steadily decreasing over the previous decade, only 22% of survivors achieve good clinical status and only 25% of patients survive until their discharge from the hospital. The objective of this scoping review was to review relevant AI modalities and the main potential applications of AI in resuscitation. Methods: We conducted the literature search for related studies in PubMed, EMBASE, and Google Scholar. We included peer-reviewed publications and articles in the press, pooling and characterizing the data by their model types, goals, and benefits. Results: After identifying 268 original studies, we chose 59 original studies (reporting 1,817,419 patients) to include in the qualitative synthesis. AI-based methods appear to be superior to traditional methods in achieving high-level performance. Conclusion: AI might be useful in predicting cardiac arrest, heart rhythm disorders, and post-cardiac arrest outcomes, as well as in the delivery of drone-delivered defibrillators and notification of dispatchers. AI-powered technologies could be valuable assistants to continuously track patient conditions. Healthcare professionals should assist in the research and development of AI-powered technologies as well as their implementation into clinical practice
Effect of Ketamine on Postoperative Neurocognitive Disorders: A Systematic Review and Meta-Analysis
No full textBackground: Neurocognitive alterations in the perioperative period might be caused by a wide variety of factors including pain, blood loss, hypotension, hypoxia, micro- and macroemboli, cardiopulmonary bypass (CPB), reperfusion damage, and surgery itself, and all are risk factors for developing postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The objective of this study was to evaluate the effect of ketamine on neurocognitive dysfunction after anesthesia. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing ketamine use (experimental group) with placebo (controls). Results: The model favors the control group over the experimental group in terms of frequency of hallucinations (the risk ratio with 95% CI is 1.54 [1.09, 2.19], p-value = 0.02), the number of patients readmitted within 30 days (RR with 95% CI is 0.25 [0.09, 0.70]), and the number of adverse events (overall RR with 95% CI is 1.31 [1.06, 1.62]). In terms of morphine consumption, the model favors the experimental group. Conclusion: There was no statistically significant difference in incidences of postoperative delirium, vasopressor requirement, and fentanyl consumption between the ketamine and control groups. However, hallucinations were more frequently reported in the ketamine group
Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved
No full textAcute liver failure affects previously healthy and often young people and has a very high mortality due to rapid multi-organ failure. The diagnosis is based on the presence of coagulopathy (International normalized ratio >2 or prothrombin rate <50%) and hepatic encephalopathy within 8 weeks of onset of jaundice in patients with no previous liver disease (1).
In resource-constrained developing countries, hepatitis A, B, and E infections, traditional medicines (2), drugs, herbal supplements (3), and halothane (4) are the main causes. Even though liver transplantation is the treatment of choice nowadays, the survival rate without liver transplantation in adults is as high as 40% in high-income countries (5, 6). Unfortunately, it is much lower in developing countries (7) where cases are diagnosed too late or considered untreatable in the absence of a transplant center.
We propose a practical approach that can be used in Intensive Care Unit-equipped hospitals in resource-constrained countries to try and reduce the high mortality rate where liver transplantation is not available
Remote Monitoring of Chronic Critically Ill Patients after Hospital Discharge: A Systematic Review
No full textBackground: Over the past few decades, critical care has seen many advancements. These advancements resulted in a considerable increase in the prevalence of chronically critically ill patients requiring prolonged medical care, which led to a massive increase in healthcare utilization. Methods: We performed a search for suitable articles using PubMed and Google Scholar from the inception of these databases to 15 May 2021. Results: Thirty-four articles were included in the review and analyzed. We described the following characteristics and problems with chronic critically ill patient management: the patient population, remote monitoring, the monitoring of physiological parameters in chronic critically ill patients, the anatomical location of sensors, the barriers to implementation, and the main technology-related issues. The main challenges in the management of these patients are (1) the shortage of caretakers, (2) the periodicity of vital function monitoring (e.g., episodic measuring of blood pressure leads to missing important critical events such as hypertension, hypotension, and hypoxia), and (3) failure to catch and manage critical physiological events at the right time, which can result in poor outcomes. Conclusions: The prevalence of critically ill patients is expected to grow. Technical solutions can greatly assist medical personnel and caregivers. Wearable devices can be used to monitor blood pressure, heart rate, pulse, respiratory rate, blood oxygen saturation, metabolism, and central nervous system function. The most important points that should be addressed in future studies are the performance of the remote monitoring systems, safety, clinical and economic outcomes, as well as the acceptance of the devices by patients, caretakers, and healthcare professionals
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