scholarly journals EFFECT OF 30° HEAD-UP POSITION ON INTRACRANIAL PRESSURE CHANGE IN PATIENTS WITH HEAD INJURY IN SURGICAL WARD OF GENERAL HOSPITAL OF Dr. R. SOEDARSONO PASURUAN

2017 ◽  
Vol 3 (3) ◽  
pp. 89-95 ◽  
Author(s):  
Sumirah Budi Pertami ◽  
Sulastyawati Sulastyawati ◽  
Puthut Anami
Keyword(s):  
Mean Arterial Pressure ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Arterial Pressure ◽  
Control Group ◽  
P Value ◽  
Increased Intracranial Pressure ◽  
Head Injured ◽  
Injured Patients ◽  
The Impact

Background: Head-injured patients have traditionally been maintained in the head-up position to ameliorate the effects of increased intracranial pressure (ICP). However, it has been reported that the 15 degrees head-up position may improve cerebral perfusion pressure (CPP) and outcome. We sought to determine the impact of 30 and 15 degrees on intracranial pressure change.Methods: This was a quasi-experimental study with posttest only control time series time design.  There were 30 head-injured patients was selected using consecutive sampling, with 15 assigned in the treatment (30° head-up position) and control group (15° head-up position). Intracranial pressure variable was identified using the level of consciousness and mean arterial pressure parameters. Wilcoxon signed rank test was used for data analysisResults: Findings showed p-value 0.010 (0.05) on awareness level and p-value 0.031 (0.05) on mean arterial pressure, which indicated that there was a statistically significant effect of the 30° head-up position on level of awareness and mean arterial pressure.Conclusion: There was a significant effect of the 30° head-up position on intracranial pressure changes, particularly in the level of awareness and mean arterial pressure in patients with head injury. It is recommended that for health workers to provide knowledge regarding this intervention to prevent increased intracranial pressure.

Succinylcholine and Intracranial Pressure

2018 ◽  
Vol 129 (6) ◽  
pp. 1159-1162 ◽  
Author(s):  
James E. Cottrell
Keyword(s):  
Mean Arterial Pressure ◽  
Intracranial Pressure ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Increased Intracranial Pressure ◽  
Hemodynamic Changes ◽  
Neurosurgical Patients ◽  
Pulmonary Arterial ◽  
Increased Icp

Abstract Intracranial and Hemodynamic Changes after Succinylcholine Administration in Cats. By Cottrell JE, Hartung J, Giffin JP, and Shwiry B. Anesthesia & Analgesia 1983; 62:1006–9. Reprinted with permission. Bolus injections of succinylcholine (1.5 mg/kg) significantly increased intracranial pressure (ICP) in cats under normal conditions from control levels of 8 +/- 1 mmHg to 16 +/- 3 mmHg (+/- SEM, P less than 0.01), and in the presence of artificially increased ICP from control levels of 27 +/- 1 mmHg to 47 +/- 4 mmHg (P less than 0.01). These approximately 100% increases in ICP were accompanied by a transitory decrease in mean arterial pressure (approximately 10 s), followed by a 15 to 20% increase (P less than 0.05). Pulmonary arterial pressure increased 20 to 30% (P less than 0.05). These results, when considered in conjunction with results previously obtained in humans, suggest that succinylcholine may be contraindicated in neurosurgical patients.

WAIS Performance during the Acute Recovery Stage following Closed-Head Injury

1993 ◽  
Vol 76 (1) ◽  
pp. 99-109 ◽  
Author(s):  
Robert E. Correll ◽  
Shirley E Brodginski ◽  
Saundra F. Rokosz
Keyword(s):  
Head Injury ◽  
Function Analysis ◽  
Block Design ◽  
Closed Head Injury ◽  
Psychiatric Inpatients ◽  
Control Group ◽  
Head Injured ◽  
Closed Head ◽  
Information Processing Deficits ◽  
Injured Patients

WAIS profiles of 50 acute closed head-injured patients were examined and compared with those of 40 psychiatric inpatients. Patients with moderate and severe, but not with mild, head injury differed significantly from the control group on level of subtest performance. There was no significant interaction of group by subtest. The groups also differed significantly on a measure of between-subtest scatter. Discriminant function analysis incorporating measures of within-subtest scatter correctly classified 89% of all subjects. Within the head-injured group Similarities and Block Design scores were elevated, and the Digit Symbol score depressed. These results indicate that closed head-injured patients can be discriminated from psychiatric inpatients on the basis of WAIS performance, but that they do not necessarily show a characteristic WAIS profile. Within-subtest scatter may indicate information-processing deficits.

Failure of prophylactic barbiturate coma in the treatment of severe head injury

1985 ◽  
Vol 62 (3) ◽  
pp. 383-388 ◽  
Author(s):  
John D. Ward ◽  
Donald P. Becker ◽  
J. Douglas Miller ◽  
Sung C. Choi ◽  
Anthony Marmarou ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Controlled Trial ◽  
Neurological Status ◽  
Treated Group ◽  
Control Group ◽  
Barbiturate Coma ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients

✓ In certain subgroups of severely head-injured patients, the mortality rate remains unacceptably high. The authors describe a randomized, controlled trial of prophylactic pentobarbital therapy in a group of these patients. Pentobarbital was started as soon as possible after the head injury, regardless of the intracranial pressure (ICP), and was continued for a prescribed period of time. The study included 53 consecutive head-injured patients over the age of 12 years, who had either an acute intradural hematoma (subdural and/or intracerebral, large enough to warrant surgical decompression), or no mass lesion but whose best motor response was abnormal flexion or extension. All patients in the study were randomly assigned to a control group (26 cases) or a pentobarbital-treated group (27 cases) once the diagnosis had been made and informed consent obtained. All patients were treated with the same protocol of aggressive resuscitation, prompt diagnosis and treatment of mass lesions, and intensive care, with close follow-up monitoring. The randomization was effective in producing a close match between the control and treated groups with respect to age, sex distribution, cause of injury, neurological status, intracranial lesions, prevalence of early systemic insults, midline shift, and initial ICP. Outcome was essentially the same in each group. There was no difference between groups in the incidence of elevated ICP, the duration of ICP elevation, or the response of ICP elevations to treatment. Arterial hypotension occurred in 14 patients (54%) in the treated group and only two patients (7percnt;) in the untreated group. Based on these data the authors cannot recommend the prophylactic use of pentobarbital coma in the treatment of patients with severe head injury. They also believe that its use is accompanied by significant side effects which can potentially worsen the condition of a patient with severe head injury.

A STUDY ON HAEMODYNAMIC RESPONSE ATTENUATION DURING HEAD HOLDER APPLICATION FOR CRANIOTOMY COMPARING IV DEXMEDITOMIDINE AND LOCAL LIGNOCAINE

2021 ◽  
pp. 28-30
Author(s):  
Jayadheer. D
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Intracranial Pressure ◽  
Arterial Pressure ◽  
Demographic Data ◽  
Hemodynamic Response ◽  
P Value ◽  
Hemodynamic Parameters ◽  
Neurosurgical Patients ◽  
Head Holder

Background; One of the goals of neuro anesthesia is to ensure stable perioperative cerebral hemodynamics, thus avoiding a sudden rise in intracranial pressure and prevent acute brain swelling.1 The intense surgical stimuli associated with craniotomy frequently causes sympathetic activation, which results in changes in heart rate (HR), blood pressure (BP), and cerebral blood ow (CBF). These changes may increase intracranial pressure (ICP) and a reduction in cerebral perfusion pressure (CPP). Finally, it leads to cerebral ischemia, especially in patients with impaired autoregulation and compromised cerebral compliance2,3. Thus, it is essential to preserve cerebral homeostasis and to prevent abrupt changes in hemodynamics. Smooth and rapid recovery from anesthesia allows immediate neurological assessment. Application of skull pin head holder is a necessity for stabilizing the head during craniotomy. Mayeld device or head holder is a clamp thatconsists of a C-shaped metal piece with three sharp interchangeable metal pins arranged triangularly to one another.4 These pins forced through the layers of scalp and periosteuminto the external lamina of the skull. Skull pins support the head without allowing any direct pressure on the face, allow access to the airway, and hold head rmly in one position that can nely be adjusted for optimal neurosurgical exposure. This study was conducted in fty ASA grade 1 or 2 patients who were adm Methods: itted at Government General Hospital, Guntur afliated to Guntur Medical College, Guntur, to undergo elective craniotomies under general anesthesia. After getting Ethical committee approval, a total of fty patients were allocated into two groups of 25 each. They were connected to the non-invasive monitors, and the basal heart rate and mean arterial pressure were recorded.Patients randomized to group dexmedetomidine received 1mcg/kg of dexmedetomidine diluted to 10ml with 0.9% saline over 10 min through a syringe pump, after recording pre-induction baseline hemodynamic parameters. Before the pin application, these patients received inltration of the pin sites with 0.9% saline (3ml for each site). Patients randomized to group lidocaine received infusion of 10ml of 0.9% saline over 10min, after recording baseline hemodynamic parameters. They then received inltration of the pre-marked pin sites with 2% lidocaine (without adrenaline), 3ml for each site. Heart rate and mean arterial pressure were recorded at various time intervals.Baseline, preinltration, post inltration, pre pin, 1 minute after post pin, 2minutes after post pin, 3 minutes, 5 miutes, 10 minutes and 15 minutes after post pin application. The result was analyzed using student t-test, and a P value of less than 0.05 was taken as signicant. ResultsWith patients matched for demographic data, the results showed there was no signicant difference in baseline values between the two groups. Heart rate and mean arterial pressure were comparable between the groups at various time intervals in the study. Thus both dexmedetomidine and lidocaine are equally effective in controlling the hemodynamic response to skull pin application. Despite being comparable to lidocaine inltration, dexmedetomidine causes signicantlymore episodes of hypotension and bradycardia, which could be detrimental in neurosurgical patients. Dexmedetomidine 1mcg/kg infusion and 2% li Conclusion gnocaine inltration both are equally effective in controlling the hemodynamic response to skull pin placement. Despite being comparable to lignocaine inltration, dexmedetomidine causes signicantly more episodes of bradycardia and hypotension, so they need rescue medication, which could be detrimental in a neurosurgical patient. We conclude that 2% of local lignocaine inltration is better in controlling hemodynamic responses to skull pin head holder application and does not cause any adverse effects in any of the patients.

Early changes of intracranial pressure, perfusion pressure, and blood flow after acute head injury

1989 ◽  
Vol 70 (5) ◽  
pp. 774-779 ◽  
Author(s):  
Ernst G. Pfenninger ◽  
Andreas Reith ◽  
Dieter Breitig ◽  
Ad Grünert ◽  
Friedrich W. Ahnefeld
Keyword(s):  
Blood Flow ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Cerebral Circulation ◽  
Perfusion Pressure ◽  
Control Group ◽  
Sudden Increase ◽  
Subsequent Increase ◽  
Systemic Hemodynamic ◽  
The Impact

✓ The present study examines intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral circulation immediately after experimental head injury in an animal model. The underlying systemic hemodynamic changes were also observed. To produce a standardized head injury, a fluid-percussion device was applied to the dura at the midline of 10 piglets. Seven other nontraumatized animals served as a control group. Hemodynamic parameters as well as ICP and CPP were recorded on-line, one value every 1.4 seconds. Cerebral blood flow (CBF) and cerebral vascular resistance (CVR) were measured three times using a microsphere technique. Immediately after head injury, the traumatized animals showed a sudden increase in ICP, with a maximum of 40 torr at 3 to 5 minutes, while there was a pronounced decrease in CPP from 85 to 40 torr. The CBF in the various brain areas fell from 55 to 22 ml/min/100 gm within 5 minutes after the impact, and CVR increased to 300% of control values within 90 minutes. The findings of this study demonstrated that cerebral circulation is critically jeopardized within a few minutes after trauma. This, in combination with a subsequent increase in CVR, makes the early development of ischemic brain damage very likely. In traumatized patients, treatment prior to hospital admission must therefore be directed at prevention of this fatal course.

scholarly journals Efek SuctionMelalui Catheter Mouth terhadap Saturasi Oksigen Pasien Cedera Kepala

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Marlisa M ◽  
Ponpon S Idjradinata ◽  
Cecep Eli Kosasih
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Oxygen Saturation ◽  
Severe Head Injury ◽  
Intervention Group ◽  
Oxygen Desaturation ◽  
Control Group ◽  
P Value ◽  
Oxygen Saturation Level ◽  
Post Test

Tindakan suction endotrachealpada pasien cedera kepala berat dapat menyebabkan terjadinya oxygendesaturationarteri yang berakibat pada peningkatan intracranial pressure, pembengkakan otak dan hipoksemiasistemikbahkan dapat menyebabkan kematian. Penelitian ini bertujuan untuk mengevaluasi pengaruh suplai oksigen melalui catheter mouthsaat suction terhadap saturasi oksigen pada pasien cedera kepala yang terpasang ventilator yang dirawat di ruang perawatan intensif. Penelitian ini menggunakan desain penelitian desain kuasi eksperimen pendekatan pre dan post test dengan kelompok kontrol dan perlakuan. Jumlah sampel pada penelitian ini adalah 40 responden yang dibagi menjadi kelompok perlakuan sebanyak 20 responden yang dipasang catheter mouthdan kelompok kontrol sebanyak 20 responden tanpa menggunakan catheter mouth. Teknik sampel menggunakan accidental sampling. Penurunan saturasi oksigen nilai thitung (-16,538) < ttabel (-2,024) dan nilai p-value(0.000) < 0.05. Saturasi oksigen saat suctionpada kelompok kontrol dengan kelompok perlakuan adalah memang berbeda secara nyata. Hasil penelitian ini dapat dijadikan evidence basedbagi perawat di ruang intensif untuk meningkatkan pelayanan perawatan dalam melakukan tindakan suctionuntuk mengurangi resiko terjadinya penurunan saturasi oksigen pada pasien cedera kepala berat yang terpasang ventilator. Kata kunci : catheter mouth, suction,saturasi oksigen AbstractThe intervention of endotracheal suction to patients with the severe head injury may have effected to oxygen desaturation in arteries. The oxygen desaturation process could be impacted to increase the intracranial pressure, brain’s swelling, hypoxemia systemic, and deaths. This study aimed to evaluate the influence of the oxygen supply via oral catheterization in the suction process to the oxygen saturation level in the patient with the severe head injury who using ventilator. This research has been conducted in the intensive care unit. This study was applied the quasi experiment design using pre and post-test. Samples were chosen using accidental sampling. There were two groups of samples, the first group was the intervention group with 20 respondents using oral catheterization, and the second group was the control group with 20 respondents. The result showed that the oxygen saturation was reduced with t value (-16.538) < t table (-2.024), and p value (0.000) < 0.05. The oxygen saturation was significantly different between two groups. This study could be an evidence that nurses should enhance their services to reduce the risk of decreasing the oxygen saturation in the severe head injury patient who using ventilator.Key words:Catheter Mouth, oxygen saturation, suction

The The Correlation of Hemodynamic Status and Oxygen Saturation with The Level of Consciousness in Head Injury Patients

2020 ◽  
Vol 1 (3) ◽  
pp. 122-130
Author(s):  
Nuril Kumalasari ◽  
Marsaid ◽  
Lingling Marinda Palupi
Keyword(s):  
Mean Arterial Pressure ◽  
Head Injury ◽  
Body Temperature ◽  
Arterial Pressure ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
P Value ◽  
Cross Sectional ◽  
Hemodynamic Status ◽  
Level Of Consciousness

Introduction: Head injury is a traumatic disorder caused by the mechanical strength of a blunt object or penetration that can cause temporary or permanent changes in tissue function and structure. The latest developing concept on poor prognosis among head injury patients was occur related to the secondary injuries, where there was an increase in intracranial, cerebral ischemia, and decreased consciousness. The important thing in the management of head injuries is to maintain hemodynamic stability and to prevent hypoxia by maintaining oxygen saturation >95%. The purpose of this study was to analyze the correlation of hemodynamic status and oxygen saturation with the level of consciousness in head injury patients at RSUD Mardi Waluyo, Blitar. Methods: The research used correlational analytical with a cross-sectional design. The sampling technique used consecutive sampling within a total sample of 30 respondents. Spearman's test was used for data analysis. Results: The results showed a correlation between mean arterial pressure (p-value = .004), respiratory rate (p-value = .000), body temperature (p-value = .017), and oxygen saturation (p-value = .000) with level of consciousness (GCS) respectively. Conclusion: It can be concluded that mean arterial pressure, respiratory rate, body temperature, and oxygen saturation can affect the level of consciousness (GCS). There was a need to improve hemodynamic and oxygen saturation monitoring to prevent the bad prognosis in head injury patients at RSUD Mardi Waluyo, Blitar.

Effect of stable xenon inhalation on intracranial pressure during measurement of cerebral blood flow in head injury

1994 ◽  
Vol 81 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Jan Plougmann ◽  
Jens Astrup ◽  
Jens Pedersen ◽  
Carsten Gyldensted
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Content Type ◽  
Head Injured ◽  
Stable Xenon ◽  
The Mean ◽  
Injured Patients ◽  
Fine Print

✓ Xenon-enhanced computerized tomography (CT) is well suited for measurements of cerebral blood flow (CBF) in head-injured patients. Previous studies indicated divergent results on whether inhalation of xenon may cause a clinically relevant increase in intracranial pressure (ICP). The authors employed Xe-enhanced CT/CBF measurements to study the effect of 20 minutes of inhalation of 33% xenon in oxygen on ICP, cerebral perfusion pressure (CPP), and arteriovenous oxygen difference (AVDO2) in 13 patients 3 days (mean 1 to 5 days) after severe head injury (Glasgow Coma Scale score ≤ 7). The patients were moderately hyperventilated (mean PaCO2 4.3 kPa or 32.3 mm Hg). Six patients were studied before and during additional hyperventilation. All 13 patients reacted with an increase in ICP and 11 with a decrease in CPP. The mean ICP increment was 6.9 ± 7.7 (range 2 to 17 mm Hg). The mean CPP decrement was −9.7 ± −14.6 (range 17 to 47 mm Hg). The time course of the ICP changes indicated that ICP increased rapidly during the first 5 to 6 minutes, then declined to a plateau (peak-plateau type in four of 13 patients), remained at a plateau (plateau type in six of 13), or continued to increase in three of 13, indicating individual variance in xenon reactivity. Additional hyperventilation had no effect on the xenon-induced increments in ICP but these occurred at lower ICP and higher CPP baseline levels. The AVDO2 values, an index of flow in relation to metabolism, indicated a complex effect of xenon on CBF as well as on metabolism. This study indicates that xenon inhalation for Xe-CT CBF measurements in head-injured patients according to our protocol causes clinically significant increments in ICP and decrements in CPP. It is suggested that the effect of xenon is analogous to anesthesia induction. Individual variations were observed indicating possible individual tolerance, possible influence of type and extent of the cerebral injury, disturbances in cerebrovascular reactivity, and possible influence of medication. These effects of xenon suggest that hyperventilation should be ensured in patients with evidence of reduced compliance or high ICP. On the other hand, inhalation of stable xenon is not believed to pose a risk because no signs of cerebral oligemia or ischemia were indicated in the AVDO2 values.

The Management of Patients with Intradural Post-Traumatic Mass Lesions: A Multicenter Survey of Current Approaches to Surgical Management in 729 Patients Coordinated by the European Brain Injury Consortium

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1183-1192 ◽  
Author(s):  
Christian Compagnone ◽  
Gordon D. Murray ◽  
Graham M. Teasdale ◽  
Andrew I.R. Maas ◽  
Domenico Esposito ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Surgical Management ◽  
Decompressive Craniectomy ◽  
Mass Lesion ◽  
Raised Intracranial Pressure ◽  
Delayed Surgery ◽  
Head Injured ◽  
Mass Lesions ◽  
Injured Patients

Abstract OBJECTIVE: Controversy exists about the indications and timing for surgery in head injured patients with an intradural mass lesion. The aim of this study was to survey contemporary approaches to the treatment of head injured patients with an intradural lesion, placing a particular focus on the utilization of decompressive craniectomy. METHODS: A prospective international survey was conducted over a 3-month period in 67 centers from 24 countries on the neurosurgical management of head injured patients with an intradural mass lesion and/or radiological signs of raised intracranial pressure. Information was obtained about demographic, clinical, and radiological features; surgical management, and mortality at discharge. RESULTS: Over the period of the study, data were collected about 729 patients consecutively admitted to one of the participating centers. The survey included 397 patients with a severe head injury (Glasgow Coma Scale [GCS] 3–8), 155 with a moderate head injury (GCS 9–12) and 143 patients with a mild head injury (GCS 13–15). An operation was performed on 502 patients (69%). Emergency surgery (&lt;24 h) was most frequently performed for patients with an extracerebral mass lesions (subdural hematomas) whereas delayed surgery was most frequently performed for an intracerebral hematoma or contusion. Decompressive craniectomy was performed in a substantial number of patients, either during an emergency procedure (n = 134, 33%) or a delayed procedure (n = 47, 31%). The decompressive procedure was nearly always combined with evacuation of a mass lesion. The size of the decompression was however considered too small in 25% of cases. CONCLUSION: The results provide a contemporary picture of neurosurgical surgical approaches to the management of head injured patients with an intradural mass lesion and/or signs of raised intracranial pressure in some Neurosurgical Units across the world. The relative benefits of early versus delayed surgery in patients with intraparenchymal lesions and on the indications, technique and benefits of decompressive craniectomy could be topics for future head injury research.

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