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Persistent Post-Extubation Stridor in an Intensive Care Unit: A Decision Dilemma 重症监护室持续的拔管后Stridor:决策困境
Q4 Medicine Pub Date : 2023-04-24 DOI: 10.1055/s-0043-1763266
S. Singh, Muazzam Hassan, Nipun Gupta, C. Mahajan
Stridor is a harsh, wheezing, often high-pitched sound produced by rapid, turbulent fl ow of air through a narrowed supraglottic region to proximal trachea and can be inspiratory, expiratory, or biphasic. 1 The incidence of post-extubation stridor varies from 2 to 42% in pediatric intensive care unit (ICU). 2 Factors like traumatic intubation, multiple attempts, prolonged intubation, use of cuffed or inappropri-ate sized tube, lower age, inadequate analgesia, and sedation are associated with signi fi cant risk of post-extubation stridor. 2,3 Here, we report a case of persistent post-extubation stridor in a patient with traumatic brain injury, who was medically managed, thus avoiding reintubation. Informed consent for reporting this case was obtained from the child ’ s parents. A 2-year-old, 15kg, male child, presented to the emer-gency department with a history of fall from the fi rst fl oor (10 – 12 feet). He was tracheally intubated with a 3.5-mm uncuffed tube in view of low Glasgow Coma Scale (GCS) of E1V2M5. Noncontrast computed tomography (CT) scan of head revealed right basifrontal contusion with fracture of right frontal bone, which was managed conservatively. Ex-tended Focused Assessment of Sonography in Trauma, CT scan of spine and torso, and X-rayof
喘鸣是由狭窄的声门上区向气管近端快速湍流气流产生的刺耳的、喘息的、常为高音的声音,可为吸气、呼气或双相。1拔管后喘鸣在儿科重症监护室(ICU)的发生率从2%到42%不等。外伤性插管、多次尝试、插管时间过长、使用带袖口或尺寸不合适的导管、年龄较低、不充分的镇痛和镇静等因素与拔管后喘鸣的显著风险相关。2,3在此,我们报告一例外伤性脑损伤患者拔管后持续喘鸣,经医学处理,避免再插管。报告这一病例的知情同意得到了儿童的父母。一名2岁,体重15公斤的男童,因从一楼(10 - 12英尺)坠落而就诊于急诊科。考虑到E1V2M5格拉斯哥昏迷评分(GCS)较低,采用3.5 mm无套管气管插管。头部CT扫描显示右侧基底额挫伤合并右侧额骨骨折,予以保守处理。创伤超声扩展聚焦评估,脊柱和躯干CT扫描,x线片
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引用次数: 0
Post-craniotomy Pain: An Update 开颅术后疼痛:最新进展
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0042-1760271
Navneh Samagh, K. Jangra, Ankita Dey
Abstract Approximately two-thirds of patients experience moderate to severe intensity pain following craniotomy. It is often undertreated due to fear of unfavorable side effects of commonly used analgesic drugs. The objectives of this review are to discuss the various aspects of acute and chronic post-craniotomy pain including its incidence, pathophysiology, diagnostic criteria, preventive strategies, and management in adult patients. The data have been consolidated based on our literature search from 1978 to 2021 using various databases including Google Scholar, Medline, and PubMed Central. We conclude that one must act at the earliest using various treatment modalities for post-craniotomy pain management.
摘要大约三分之二的患者在开颅术后出现中度至重度疼痛。由于担心常用镇痛药物的不良副作用,它经常治疗不足。这篇综述的目的是讨论开颅术后急性和慢性疼痛的各个方面,包括成年患者的发病率、病理生理学、诊断标准、预防策略和管理。根据我们1978年至2021年的文献搜索,使用谷歌学者、Medline和PubMed Central等各种数据库对数据进行了整合。我们的结论是,必须尽早采取行动,使用各种治疗方式进行开颅术后疼痛管理。
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引用次数: 0
Reversible Cerebral Vasoconstriction Syndrome Treated by Continuous Intravenous Milrinone 持续静脉注射米力农治疗可逆性脑血管收缩综合征
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0043-1761248
Hilaire de Malleray, S. Gazzola, E. Meaudre, P. Esnault
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches, with or without other acute neurological symptoms, and diffuse segmental con-striction of cerebral arteries that resolves spontaneously within 3 months. 1 It can occur spontaneously, especially in middle-aged women 1 ; at least half the cases occur after exposure to vasoactive drugs or post-partum. This syndrome is often associated with a favorable outcome in 95% of cases. 1 However, the prognosis of RCVS is especially determined by stroke occurrence. Its management is inspired by what is applied in aneurysmal subarachnoid hemorrhage (aSAH), whose main complication is vasospasm and delayed cerebral ischemia (DCI). Although the physiopathology of RCVS is unclear, it appears to be distinct from aSAH. Indeed, the vasoconstriction in RCVS may be dependent on the activity and sensitivity of vascular receptors, which can lead to a more systemic effect on all brain vessels, as opposed to being dependent on the vasospasm induced by local clot lysis, as has been suggested in aSAH. 2 As cerebral arteries are densely innervated, the release of norepinephrine or neuropeptide Y from the sympathetic nerve endings may cause vasocon-strictions. 3 Angiographically, SAH-induced vasospasm is more commonly long-segmental and mainly around the bleeding focus, compared with the multiple,
可逆性脑血管收缩综合征(RCVS)的特征是严重头痛,伴有或不伴有其他急性神经系统症状,以及脑动脉弥漫性节段性狭窄,可在3个月内自行缓解。1它可以自发发生,尤其是在中年妇女中1;至少一半的病例发生在接触血管活性药物或产后。在95%的病例中,这种综合征通常与良好的结果有关。1然而,RCVS的预后尤其取决于中风的发生。其治疗受到动脉瘤性蛛网膜下腔出血(aSAH)的启发,其主要并发症是血管痉挛和延迟性脑缺血(DCI)。尽管RCVS的生理病理学尚不清楚,但它似乎与aSAH不同。事实上,RCVS的血管收缩可能取决于血管受体的活性和敏感性,这可能会对所有脑血管产生更系统的影响,而不是依赖于局部血栓溶解诱导的血管痉挛,正如在aSAH中所提出的那样。2由于脑动脉受到密集的神经支配,交感神经末梢释放去甲肾上腺素或神经肽Y可能导致血管收缩。3从血管造影上看,SAH诱导的血管痉挛更常见于长段性,主要发生在出血灶周围,与多发性相比,
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引用次数: 0
Clinicoradiological and Biochemical Predictors of Mortality in Hospitalized Patients of Spontaneous Intracerebral Hemorrhage 自发性脑出血住院患者死亡率的临床放射学和生化预测指标
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0042-1760272
Bhagyashri B. Wankhade, Ashok Kumar V, Sanaullah Mudassir, A. Ranjan
Abstract Background  Intracerebral hemorrhage (ICH) is a cerebrovascular insult leading to bleeding within the brain parenchyma. It is associated with high rate of mortality and morbidity. The main objective of our study was to study in-hospital predictors of mortality in patients with spontaneous ICH managed medically. Methods  This was a single-center prospective study and patients of ICH meeting the inclusion criteria were recruited from March 2019 to December 2020. Demographic data were collected and brain imaging was done. Each patient was observed for outcome with either discharge or death. Results  Total 202 patients of ICH were included in the study. Mean age of the patients was 58.46 ± 11.6 years (26–95 years), which included 75.25% males. Most common location of ICH was gangliocapsular (42.08%) followed by thalamus (37.13%). Overall mortality was 35.60% ( n  = 72). On univariate analysis, predictors of mortality were higher age, low Glasgow coma scale (GCS) score, intraventricular extension, volume of hematoma, raised ICH score, leucocytosis, raised creatinine, hypernatremia, and ventilatory support. Need for ventilatory support, raised serum creatinine, and low GCS was found to be independent predictor of mortality on multivariate analysis. Conclusion  Our study showed that about one-third of ICH patient died during in-hospital management. Mechanical ventilation requirement, low GCS, and raised creatinine were found to be independent predictors of mortality in our study.
背景脑出血是一种导致脑实质出血的脑血管损伤。它与高死亡率和发病率有关。本研究的主要目的是研究医学治疗自发性脑出血患者死亡率的院内预测因素。方法本研究为单中心前瞻性研究,于2019年3月至2020年12月招募符合纳入标准的脑出血患者。收集了人口统计数据并进行了脑成像。观察每位患者出院或死亡的结局。结果共纳入202例脑出血患者。患者平均年龄58.46±11.6岁(26 ~ 95岁),男性占75.25%。脑出血最常见部位为神经节囊(42.08%),其次为丘脑(37.13%)。总死亡率为35.60% (n = 72)。在单因素分析中,死亡率的预测因子为较高的年龄、较低的格拉斯哥昏迷评分(GCS)评分、脑室内扩张、血肿体积、ICH评分升高、白细胞增多、肌酐升高、高钠血症和呼吸支持。在多变量分析中发现,需要呼吸机支持、血清肌酐升高和低GCS是死亡率的独立预测因子。结论约三分之一的脑出血患者在住院治疗过程中死亡。在我们的研究中,机械通气需求、低GCS和肌酐升高被发现是死亡率的独立预测因子。
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引用次数: 0
A Decade with the Journal of Neuroanaesthesiology and Critical Care (JNACC): Reminiscing the Chronicles 《神经麻醉学与危重症护理杂志》(JNACC)的十年:回忆编年史
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0043-1768956
G. Rath, P. Bithal
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引用次数: 0
An Acromegalic Patient with Sickle Cell Disease Undergoing Endoscopic Trans-Sphenoidal Surgery: Anesthetic Concerns for a Neuroanesthesiologist 一名患有镰状细胞病的肢端肥大症患者接受内镜下跨蝶窦手术:神经麻醉师的麻醉问题
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0042-1760273
Priya Thappa, N. Panda
Abstract Sickle cell disease (SCD) refers to a group of hemoglobinopathies that include mutations in the gene encoding the β subunit of hemoglobin. The glutamine in the heme portion of the hemoglobin molecule is abnormally substituted by valine. Sickle hemoglobin (hemoglobin type S), when gets deoxygenated, tends to polymerize and aggregate leading to vaso-occlusion and organ ischemia. Such patients are at increased risk of perioperative mortality and severe complications like vaso-occlusive crisis, acute chest syndrome, and congestive heart failure. We describe the perioperative management of a case of SCD with acromegaly scheduled for trans-sphenoidal removal of a functional pituitary adenoma. The acromegalic habitus, the cardiovascular effects of acromegaly, and the hormonal imbalances due to pituitary adenoma pose challenges in addition to the challenge of preventing complications of SCD making the anesthetic management more exigent.
摘要镰状细胞病(SCD)是指一组血红蛋白病,包括编码血红蛋白β亚基的基因突变。血红蛋白分子血红素部分的谷氨酰胺被缬氨酸异常取代。镰状血红蛋白(S型血红蛋白)在脱氧时往往会聚合和聚集,导致血管闭塞和器官缺血。这类患者围手术期死亡率和严重并发症的风险增加,如血管闭塞危象、急性胸部综合征和充血性心力衰竭。我们描述了一例SCD伴肢端肥大症的围手术期处理,该病例计划经蝶窦切除功能性垂体腺瘤。肢端肥大症的习惯、肢端肥大的心血管影响以及垂体腺瘤引起的激素失衡,除了预防SCD并发症的挑战外,还带来了挑战,这使得麻醉管理更加紧迫。
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引用次数: 0
Use of Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review 高渗盐水在神经麻醉和神经危重症护理实践中的应用:叙述性综述
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0043-1763264
A. Barik, Priya Thappa, K. Jangra, H. Bhagat, Kirandeep Kaur
Abstract Hypertonic saline (HTS) is a group of fluids containing sodium and chloride in a higher concentration as compared to physiological saline. The authors have conducted this review to evaluate the use of HTS in neuroanesthesia and neurocritical care. The articles for this narrative review on HTS were searched on databases like PubMed Central, EMBASE, and Google Scholar using the Medical Subject Headings keywords “Hypertonic Saline,” “Neuroanesthesia,” and “Neurocritical Care.” The review focuses on the mechanisms of HTS and its in routine clinical practice. The results of various comparative studies between HTS and mannitol and guidelines regarding the use of HTS have also been reviewed. HTS can be used to treat hyponatremia, reduce intracranial pressure, provide intraoperative relaxed brain, and aid in resuscitation during cardiogenic, neurogenic, and septic shock. Its side effects include renal toxicity in the case of hypernatremia, rebound intracranial hypertension, volume overload, dyselectrolytemia, phlebitis, local tissue damage, and osmotic demyelination syndrome in the case of rapid correction of serum sodium concentration.
摘要高渗盐水(HTS)是一组与生理盐水相比含有更高浓度钠和氯化物的液体。作者进行了这篇综述,以评估HTS在神经麻醉和神经危重症护理中的应用。这篇关于HTS的叙述性综述的文章在PubMed Central、EMBASE和Google Scholar等数据库中使用医学主题标题关键词“高渗盐水”、“神经麻醉”和“神经危重症护理”进行了搜索。该综述侧重于HTS的机制及其在常规临床实践中的作用。还回顾了HTS和甘露醇之间的各种比较研究结果以及HTS使用指南。HTS可用于治疗低钠血症,降低颅内压,提供术中放松的大脑,并在心源性、神经性和感染性休克期间帮助复苏。其副作用包括高钠血症时的肾毒性、反弹性颅内高压、容量超负荷、电解质紊乱、静脉炎、局部组织损伤,以及血清钠浓度快速校正时的渗透性脱髓鞘综合征。
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引用次数: 0
Malignant Hyperthermia Like Manifestations during Management of Refractory Status Epilepticus 难治性癫痫持续状态治疗中的恶性热疗样表现
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0042-1756433
Deepti B. Srinivas, V. Keshavan, V. Kamath, Manju Manmadhan
Abstract Management of refractory status epilepticus is challenging for a neurointensivist consequent to systemic complexities associated with various drugs and modalities involved in its treatment. We report one such case that manifested with multiple signs of malignant hyperthermia following use of isoflurane to control seizures. However, the delayed and random occurrence of the signs and negative genetic test report raises doubts regarding the final diagnosis. Delayed presentation of malignant hyperthermia has been reported earlier. Unavailability of dantrolene sodium handily is a major hurdle in treating such cases. We enumerate management of the patient in our intensive care unit.
摘要难治性癫痫持续状态的治疗对神经强化医生来说是一项挑战,因为与各种药物和治疗方式相关的系统复杂性。我们报告了一个这样的病例,在使用异氟烷控制癫痫发作后,表现出多种恶性高热迹象。然而,症状的延迟和随机出现以及阴性基因检测报告引发了对最终诊断的怀疑。恶性热疗的延迟表现早有报道。丹特罗林钠的不可用性是治疗此类病例的主要障碍。我们列举了重症监护室对病人的管理。
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引用次数: 0
Phenytoin-Induced Red Discoloration of Urine in a Pediatric Neurosurgical Patient: An Unusual Finding 苯妥英引起的小儿神经外科病人尿液红色变色:一个不寻常的发现
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0043-1763263
S. Kadian, S. Chakraborty, Shreya Vuppalapati, S. Agrawal
The use of phenytoin is widespread in neurosurgical patients, especially in space-occupying lesions. It has pre-dominant renal excretion and has been known to cause tubulointerstitial nephritis on chronic use. Despite its com-mon use, there has not been de fi nitive literature on urine discoloration due to phenytoin except for a commentary dated back in 1983 which refuted the fi nding of urine discoloration by phenytoin use. 1 Hence, we intend to high-light a case where there was episode of red discoloration of urine in a pediatric patient posted for excision of the cerebellar tumor under general anesthesia. A 9-year-old female, weighing 30kg, presented to the neurosurgical department with complaints of headache and vomiting for 1 month. On examination, her Glasgow Coma Scale was E4V5M6 with no neurological de fi cit, left side cerebellar signs were positive, including dysdiadokine-sia and fi nger nose test. Contrast-enhanced magnetic resonance imaging revealed a 3 (cid:1) 3.5 (cid:1) 4cm lesion in the left cerebellar hemisphere with mild hydrocephalus ( ► Fig. 1 ). She was started on tablet levetiracetam 300mg twice daily, syrup glycerol three tablespoons four times a day, and tablet acetazolamide 250 mg twice daily. She was posted
苯妥英在神经外科患者中广泛使用,尤其是在占位性病变中。它具有优先的肾脏排泄,并且已知在长期使用时会导致肾小管间质性肾炎。尽管其用途广泛,但除了1983年的一篇评论驳斥了使用苯妥英导致尿液变色的结论外,还没有关于苯妥英引起尿液变色的明确文献。1因此,我们打算重点报道一名在全身麻醉下接受小脑肿瘤切除手术的儿童患者出现尿液红色变色的情况。一名9岁女性,体重30公斤,因头痛和呕吐向神经外科就诊1个月。在检查中,她的格拉斯哥昏迷量表为E4V5M6,无神经损伤,左侧小脑体征呈阳性,包括舒张因子异常和长鼻试验。对比增强磁共振成像显示左小脑半球有3(cid:1)3.5(cid:1)4cm的病变,伴有轻度脑积水(► 图1)。她开始服用左乙拉西坦300mg片剂,每日两次,甘油糖浆三汤匙,每日四次,乙酰唑胺250mg片剂,每天两次。她被张贴了
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引用次数: 1
Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022 年度回顾:2022年神经麻醉和神经危重症护理精选文章摘要
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1055/s-0043-1763268
K. Nijs, S. Chhabra, L. Venkatraghavan
Abstract This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2022 (January–November 2022). The journals reviewed include anesthesia journals, critical care medicine journals, neurosurgical journals as well as high-impact medical journals such as the Lancet , Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and Stroke . The summary of important articles will serve to update the knowledge of neuroanesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical cases.
本文综述了2022年(2022年1月至11月)神经科学、神经麻醉和神经危重症护理领域的文章摘要。这些期刊包括麻醉期刊、重症医学期刊、神经外科期刊以及高影响力的医学期刊,如《柳叶刀》、《美国医学会杂志》(JAMA)、《新英格兰医学杂志》(NEJM)和《中风》。重要文章的总结将有助于更新神经麻醉师和其他围手术期医生的知识,他们提供神经外科和神经危重病例的护理。
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引用次数: 0
期刊
Journal of Neuroanaesthesiology and Critical Care
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