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Early prediction of the outcome in severe head injury by means of auditory brainstem responses (ABR): correlation with CT scan and clinical signs of brainstem damage.
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ASSESSMENT OF BRAIN-STEM DYSFUNCTION IN SEVERE HEAD-INJURY - CORRELATION BETWEEN SOMATOSENSORY EVOKED-POTENTIALS AND AUDITORY BRAIN-STEM RESPONSES
No full textInvolvement of long-chain acyl CoA in the antagonistic effects of halothane and L-carnitine on mitochondrial energy-linked processes.
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Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power.
No full textRole of short latency evoked potentials in the diagnosis of brain death
No full textThe aim of this study is to confirm the effectiveness of ABRs and SEPs in a large series.
METHODS: 130 brain dead patients (age range 8-77 years, 81 M and 49 F) were included in the study: ABRs were recorded in 128 cases and SEPs in 109. 24 cases were submitted to serial ABR and SEP monitoring from preterminal conditions through BD, to check the process of dying.
The causes of coma were head injury in 65 cases (50%), brain haemorrhage in 52 (40%), post-anoxic coma in 7 (5.4%), brain tumor in 5 (3.8%) and encephalitis in 1 (0.8%).
RESULTS: ABRs were absent in 92 cases (71.9%), only wave I or I-II were present in 32 cases (25%), while in the remaining 4 patients (3.1%) the V and/or III waves were still present, excluding the death of the brain stem.
In 4 cases (3.7%) SEPs showed the absence of all components following the “peripheral” N9 (generated in the brachial plexus); in 103 cases (94.4%) all the components following the “far-field” P11 or P13 were absent, showing the arrest of conduction at the level of foramen magnum. SEPs excluded the diagnosis of brain stem death in 2 cases (1.9%), in whom the far field N18 (generated in the lower brain stem) was still present. In all preterminal patients the far-field N18 was present, and its disappearance was closely related to the onset of apnoea.
CONCLUSIONS: a) Both ABRs and SEPs showed a close correlation with the clinical picture of brain death; b) Their combined use was able to confirm the death of the brain stem in some 95% of cases (providing an objective confirmation of the diagnosis), and to exclude it in 4 clinically brain dead patients, thus improving the reliability of diagnosis
Influence of acupuncture on the postoperative complications following ketamine anesthesia. The importance of manual stimulation of point R and shen menn
No full textThe Authors have investigated the antihallucinogenic and sedative effects of auricular points R and shen menn during surgery under ketamine anesthesia. The results demonstrate that the insertion of the needle in point R is very efficient in reducing hallucinations of ketamine emergence, while the insertion of needle in auricular point shen menn causes only a brief period of sedation in the beginning of the emergence period. The acupunctural technique employed by the Authors has been shown to increase considerably approbation of ketamine anesthesia
Auditory and somatosensory evoked potentials in brain-dead patients
No full textThe short latency evoked potentials, allowing to assess the brain stem's function, can supply useful information in the diagnosis of Brain Death (BD). 15 BD patients were submitted to the auditory brain stem response (ABR); in 7 cases somatosensory evoked potentials from the medial nerve (SEP) were also recorded. The ABR was absent in 11 cases (73.3%), while in 3 cases only the I wave was present (20%); in one case the low-voltage I-V waves were present. Regarding the SEP, in 3 cases (42.9%) only the N9-N13 and P9-P13 waves were present, while in another 3 cases (42.9%) a N13/P13 dissociation was observable. In the remaining case, which presented a still reproducible I-V interval, the SEP was normal, thus excluding the diagnosis of BD. The ABR and the SEP, which are not roughly influenced by general anaesthetics and sedatives, are thus helpful in diagnosing BD. The SEP seems able to supply useful information more frequently than the ABR, but their combined use can guarantee maximum security of excluding false positives
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