Risk factors for intraoperative hypotension in traumatic intracranial hematoma

Traumatic brain injury (TBI) is an escalating problem with an almost geometric progression. The problem escalated with increasing population and traffic, but with limited resources to handle the issue.1,2 The present study has its objective focused on making a prognosis of the TBI patient.3 The outcome prediction helps in conveying the prognosis to the patient’s family. Needless to say, a prognostic prediction is also helpful in the optimal and timely utilization of available resources.

Download Full-text

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

10.21203/rs.3.rs-16106/v1 ◽

2020 ◽

Author(s):

Soohyuk Yoon ◽

Seokha Yoo ◽

Min Hur ◽

Sun-Kyung Park ◽

Hyung-Chul Lee ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Bispectral Index ◽

Odds Ratio ◽

Postoperative Mortality ◽

Anesthetic Depth ◽

Intraoperative Hypotension ◽

Cumulative Duration ◽

The Relationship ◽

Cumulative Time

Abstract Background The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

Download Full-text

Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017506 ◽

2021 ◽

pp. neurintsurg-2021-017506

Author(s):

Heng Ni ◽

Lin-Bo Zhao ◽

Sheng Liu ◽

Zhen-Yu Jia ◽

Yue-Zhou Cao ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Neurological Status ◽

External Ventricular Drainage ◽

Anterior Communicating Artery ◽

Intracranial Hematoma ◽

Factors Associated ◽

Independent Variable ◽

Logistic Regressions ◽

Significant Factors

BackgroundTo determine the risk factors for intracranial hematoma (ICH) development following ruptured anterior communicating artery (AcomA) aneurysms and to determine prognostic factors associated with unfavorable outcomes after coiling first.MethodsFrom March 2014 to February 2020, 235 patients with ruptured AcomA aneurysms underwent endovascular treatment in our department. The clinical and radiographic conditions were collected retrospectively. Modified Rankin Scale (mRS) scores of ≤ 2 were accepted as favorable outcomes. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to the incidence of ICHs and to unfavorable outcomes.ResultsOf these 235 patients, 68 had additional ICHs. A posterior orientation of ruptured AcomA aneurysms was the independent variable associated with the incidence of ICHs (OR 3.675; p<0.001). Furthermore, having preoperative Hunt–Hess grades Ⅳ–Ⅴ was an independent variable associated with unfavorable outcomes for ICH patients (OR 80.000; p<0.001). Among the 68 patients with ICHs, 40% (27/68) had Hunt–Hess grades IV–V. Four percent of patients (3/68) underwent surgical hematoma evacuation after the coiling procedure and 15% of the patients (10/68) underwent external ventricular drainage. A favorable outcome was achieved in 72% (49/68) of patients with ruptured AcomA aneurysms. The mortality rate was 21% (14/68) at 6 months.ConclusionA posterior orientation of ruptured AcomA aneurysms was associated with the incidence of ICHs. Coiling first with surgical management if necessary seems to be an acceptable treatment for ruptured AcomA aneurysms with ICHs. The clinical outcome was associated with the clinical neurological status on admission.

Download Full-text

Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury

Anesthesiology ◽

10.1097/aln.0000000000003063 ◽

2020 ◽

Vol 132 (3) ◽

pp. 461-475 ◽

Cited By ~ 9

Author(s):

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Validation Cohort ◽

Kidney Injury ◽

Preoperative Risk ◽

Intraoperative Hypotension

Abstract Background Despite the significant healthcare impact of acute kidney injury, little is known regarding prevention. Single-center data have implicated hypotension in developing postoperative acute kidney injury. The generalizability of this finding and the interaction between hypotension and baseline patient disease burden remain unknown. The authors sought to determine whether the association between intraoperative hypotension and acute kidney injury varies by preoperative risk. Methods Major noncardiac surgical procedures performed on adult patients across eight hospitals between 2008 and 2015 were reviewed. Derivation and validation cohorts were used, and cases were stratified into preoperative risk quartiles based upon comorbidities and surgical procedure. After preoperative risk stratification, associations between intraoperative hypotension and acute kidney injury were analyzed. Hypotension was defined as the lowest mean arterial pressure range achieved for more than 10 min; ranges were defined as absolute (mmHg) or relative (percentage of decrease from baseline). Results Among 138,021 cases reviewed, 12,431 (9.0%) developed postoperative acute kidney injury. Major risk factors included anemia, estimated glomerular filtration rate, surgery type, American Society of Anesthesiologists Physical Status, and expected anesthesia duration. Using such factors and others for risk stratification, patients with low baseline risk demonstrated no associations between intraoperative hypotension and acute kidney injury. Patients with medium risk demonstrated associations between severe-range intraoperative hypotension (mean arterial pressure less than 50 mmHg) and acute kidney injury (adjusted odds ratio, 2.62; 95% CI, 1.65 to 4.16 in validation cohort). In patients with the highest risk, mild hypotension ranges (mean arterial pressure 55 to 59 mmHg) were associated with acute kidney injury (adjusted odds ratio, 1.34; 95% CI, 1.16 to 1.56). Compared with absolute hypotension, relative hypotension demonstrated weak associations with acute kidney injury not replicable in the validation cohort. Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Chronic Subdural Hematoma after External Decompression in Traumatic Intracranial Hematoma

Neurologia medico-chirurgica ◽

10.2176/nmc.27.122 ◽

1987 ◽

Vol 27 (2) ◽

pp. 122-126 ◽

Cited By ~ 1

Author(s):

Shuichi OKI ◽

Takashi YOSHIHARA ◽

Masuki KOBAYASHI ◽

Shiro KAJIHARA ◽

Katsuaki SAKODA ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Intracranial Hematoma ◽

Traumatic Intracranial Hematoma

Download Full-text

90. Traumatic Intracranial Hematoma, Major Factors which determin its Prognosis

Neurologia medico-chirurgica ◽

10.2176/nmc.6.131 ◽

1964 ◽

Vol 6 (0) ◽

pp. 131-131

Author(s):

M. TSURU ◽

T. TAKEDA ◽

K. YADA ◽

T. KASHIWABA

Keyword(s):

Intracranial Hematoma ◽

Major Factors ◽

Traumatic Intracranial Hematoma

Download Full-text

Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04966-3 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Sizheng Zhan ◽

Wenyong Xie ◽

Ming Yang ◽

Dianying Zhang ◽

Baoguo Jiang

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fracture ◽

Kidney Injury ◽

Intraoperative Hypotension ◽

Neck Fracture ◽

Potential Risk Factors ◽

Independent Risk Factors ◽

Postoperative Aki

Abstract Background Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture. Methods We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). Results A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001) Conclusion The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

Download Full-text