General anesthesia in patient with  Brain Injury

Ali Anwar Al-kuraishy; Husam Jamal Jalil; Alaa Saleh Mahdi; Hany Al-hussaniy

doi:10.55940/medphar20222

Authors

Ali Anwar Al-kuraishy Department of Surgery, Al-Karama Hospital, Baghdad Health Department, Karkh, Iraq https://orcid.org/0000-0001-6817-0223
Husam Jamal Jalil Department of Surgery, Al-Karama Hospital, Baghdad Health Department, Karkh, Iraq
Alaa Saleh Mahdi Department of pharmaceutics collage – Pharmacy Department – Al-bayan – University – Baghdad _ Iraq
Hany Al-hussaniy Department of pharmacology collage of medicine , University of Baghdad . Iraq https://orcid.org/0000-0003-2647-8574

DOI:

https://doi.org/10.55940/medphar20222

Keywords:

Blood-Brain Barrier, Anesthesia, Intravenous Post-Traumatic, Brain Injuries, Cerebrovascular Circulation, Intracranial Hypertension

Abstract

The basic concept of Neuroanesthesia & Neuro Critical Care is the ABCDE of neuroanesthesia.
Early Brain Injury (EBI) was formerly known as primary brain injury. In EBI, there is a loss of autoregulation and loss of blood-brain barrier integrity. The presence of Cushing's triad indicates the presence of intracranial hypertension. The target of blood pressure in traumatic brain injury (TBI) is to avoid blood pressure systolic <110 mmHg, maintain cerebral perfusion pressure
(CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35–40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post-traumatic seizures (late PTS).
There is still a need to analyse decompressive craniectomy (DECRA) therapy compared with continued medical treatment for refractory intracranial pressure (ICP) elevations after TBI. General anesthesia for patients with severe TBI is preferable to total intravenous anesthesia (TIVA). The administration of fluids should consider the osmolarity of these fluids. In the new concept, in patients with elevated ICP, the volatile anesthetic concentration should be limited to 0.5 MAC. The target blood sugar is normoglycemia. Prophylactic or therapeutic hypothermia appears to have no place in managing severe brain injury.

References

Gupta D, Sharma D, Kannan N, et al. Guideline Adherence and Outcomes in Severe Adult Traumatic Brain Injury for the CHIRAG (Collaborative Head Injury and Guidelines) Study. World Neurosurg. 2016;89:169-179. doi:10.1016/j.wneu.2015.12.097

Volovici V, Steyerberg EW, Cnossen MC, et al. Evolution of Evidence and Guideline Recommendations for the Medical Management of Severe Traumatic Brain Injury. J Neurotrauma. 2019;36(22):3183-3189.

doi:10.1089/neu.2019.6474

Rass V, Helbok R. Early Brain Injury After Poor-Grade Subarachnoid Hemorrhage. Curr Neurol Neurosci Rep. 2019;19(10):78.

doi:10.1007/s11910-019-0990-3.

Pang J, Chen Y, Kuai L, et al. Inhibition of Blood-Brain Barrier Disruption by an Apolipoprotein E-Mimetic Peptide Ameliorates Early

Brain Injury in Experimental Subarachnoid Hemorrhage. Translational Stroke Research. 2017 Jun;8(3):257-272. DOI: 10.1007/s12975-016-0507-

. Gropper MA, Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener-Kronish JP. Miller's anesthesia. 2020.

D'Souza S. Neuroanesthesia Updates 2020.

Li Y, Wu P, Bihl JC, Shi H. Underlying Mechanisms and Potential Therapeutic Molecular Targets in Blood-Brain Barrier Disruption after Subarachnoid Hemorrhage. Curr Neuropharmacol. 2020;18(12):1168-1179. doi:10.2174/1570159X18666200106154203

Abdelmalik PA, Draghic N, Ling GSF. Management of moderate and severe traumatic brain injury. Transfusion. 2019;59(S2):1529-1538. doi:10.1111/trf.15171

Alkuraishy HM, Al-Gareeb AI, Al-hussaniy HA. Doxorubicin-induced cardiotoxicity: molecular mechanism and protection by conventional drugs and natural products. Int J Clin Oncol Cancer Res.

;2(2):31-44.

Volovici V, Steyerberg EW, Cnossen MC, Haitsma IK, Dirven CM, Maas AI, Lingsma HF. Evolution of evidence and guideline recommendations for the medical management of severe traumatic brain injury. J. Neurotrauma. 2019;36(22):3183-9.

Vincent JL, Nielsen ND, Shapiro NI, Gerbasi ME, Grossman A,Doroff R, Zeng F, Young PJ, Russell JA. Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database. Ann. Intensive Care. 2018;8(1):1-0

Korte N, Nortley R, Attwell D. Cerebral blood flow decrease as an early pathological mechanism in Alzheimer's disease. Acta Neuropathol. 2020;140(6):793-810..

Claassen JA, Thijssen DH, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of

autoregulation. Physiol. Rev. 2021 ;101(4):1487-559.

Thiele EL, Nemergut EC. Miller’s anesthesia. Anesthesia & Analgesia. 2020 Jun 1;130(6):e175-6.

Al-Hassany HA, Albu-Rghaif AH, Naji MA. Tumor diagnosis by genetic markers protein P-53, p16, C-MYC, N-MYC, protein KRas, and gene her-2 Neu is this possible?. Pak J Med Health Sci 2021;15(8):2350-4.

Claassen JA, Thijssen DH, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of

autoregulation. Physiological reviews. 2021 ;101(4):1487-559.

Singh P, Stutzman SE, Venkatachalam A, Olson DM, Barnes A, Atem FD. Identification of abnormal pupil dilation velocity as a biomarker of cerebral injury in neurocritically ill patients. Revista Brasileira de Terapia Intensiva. 2021 ;33:412-21.

Sridharan K, Sivaramakrishnan G. Comparison of fentanyl, Remifentanil, Sufentanil and Alfentanil in combination with Propofol for

general anesthesia: a systematic review and meta-analysis of randomized controlled trials. Current clinical pharmacology. 2019 ;14(2):116-24.

Zhang C, Huang D, Zeng W, Ma J, Li P, Jian Q, Huang J, Xie H. Effect of additional equipotent fentanyl or sufentanil administration on

recovery profiles during propofol-remifentanil–based anaesthesia in patients undergoing gynaecologic laparoscopic surgery: a randomized clinical trial. BMC anesthesiology. 2022;22(1):1-7.

Al-Hussaniy HA, Alburghaif AH, Naji MA. Leptin hormone and its effectiveness in reproduction, metabolism, immunity, diabetes, hopes and ambitions. Journal of Medicine and Life. 2021;14(5):600.-5

Ronel I, Weiniger CF. Non-regional analgesia for labour: remifentanil in obstetrics. BJA education. 2019;19(11):357.

Le Roux P. Management of Head Trauma in the Neurocritical Care Unit. Pathology. 2019;28:30.

Karanci Y, Oktay C. Repeat CT after blunt head trauma and Glasgow Coma Scale score 13–15 without neurological deterioration is

very low yield for intervention. European journal of trauma and emergency surgery. 2022;48(2):1069-76.

Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD.

Guidelines for the safe practice of total intravenous anaesthesia (TIVA) joint guidelines from the association of anaesthetists and the society for intravenous anaesthesia. Anaesthesia. 2019;74(2):211-24.

Bellgardt M, Drees D, Vinnikov V, Procopiuc L, Meiser A, Bomberg H, Gude P, Vogelsang H, Weber TP, Herzog-Niescery J. Use of

the MIRUS™ system for general anaesthesia during surgery: a comparison of isoflurane, sevoflurane and desflurane. Journal of clinical monitoring and computing. 2018;32(4):623-7.

Verellen RM, Cavazos JE. Post-traumatic epilepsy: an overview. Therapy. 2010;7(5):527.

Suárez PM, Santotoribio JD, Ramos VR, García MÁ, Ramos SP, Huertas DP, Hoyos AM. Brain damage after general anesthesia. Medicina Clínica (English Edition). 2016;146(9):384-8.

Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. Journal of neurosurgery. 1991;75(4):545-51.

Fang T, Valdes E, Frontera JA. Levetiracetam for Seizure Prophylaxis in Neurocritical Care: A Systematic Review and Meta-analysis.

Neurocrit Care. 2022;36(1):248-258.

Klyuev, S. A., Goremykin, I. V., Masevkin, V. G., Gorodkov, S. Y., Nikolaev, A. V., Shintaev, T. K., & Azizoğlu, M. Acute Gastric Dilation

With Necrosis: Case Report And Literature Review. Journal of Clinical Trials and Experimental Investigations, 1(2), 32–46.

https://doi.org/10.5281/zenodo.7007932

Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J. Trial

of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375:1119-30.

Lemkuil PB, Drummond JC, Patel PM, Lam AR. Anesthesia for neurologic surgery and neurointerventions. Miller’s Anesthesia, 9th ed, Philadelphia: Elsevier. 2020:1868-910.

Saco‐Ledo G, Valenzuela PL, Castillo‐García A, Arenas J, León‐Sanz M, Ruilope LM, Lucia A. Physical exercise and epicardial adipose tissue: a systematic review and meta‐analysis of randomized controlled trials. Obesity Reviews. 2021 Jan;22(1):e13103.

Hermanides J, Plummer MP, Finnis M, Deane AM, Coles JP, Menon DK. Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis. J. Crit. Care. 2018;22(1):1-1.

Cefalu WT. Mortality and glycemic targets in the intensive care unit: another paradigm shift?. Diabetes. 2009;58(7):1469-70.

Dietrich WD. New Targets for Temperature Management. Ther. Hypothermia Temp. Manag. 2015;5(3):115-.

Presneill J, Gantner D, Nichol A, McArthur C, Forbes A, Kasza J, Trapani T, Murray L, Bernard S, Cameron P, Capellier G. Statistical analysis plan for the POLAR-RCT: The Prophylactic hypOthermia trial to Lessen trAumatic bRain injury-Randomised Controlled Trial. Trials. 2018;19(1):1-0.

Crowley JS, Geller AB, Vermund SH, National Academies of Sciences, Engineering, and Medicine. Patterns and Drivers of STIs in the

United States. InSexually Transmitted Infections: Adopting a Sexual Health Paradigm 2021 Mar 24. National Academies Press (US).

Akeel Naji H. The Psychosocial and Economic Impact of Uveitis in Iraq. RABMS. 2021; 7 (4) :207-215

Yan M, Chen L, Yang M, Zhang L, Niu M, Wu F, Chen Y, Song Z, Zhang Y, Li J, Tian J. Evidence mapping of clinical practice guidelines

recommendations and quality for depression in children and adolescents. European Child & Adolescent Psychiatry. 2022 Mar 9:1-8.

DOI: 10.1007/s00787-022-01958-z

Watson HI, Shepherd AA, Rhodes JKJ, Andrews PJD. Revisited: A Systematic Review of Therapeutic Hypothermia for Adult Patients

Following Traumatic Brain Injury. Crit Care Med. 2018;46(6):972-979. doi:10.1097/CCM.0000000000003125.

Shipley L, Gale C, Sharkey D. Trends in the incidence and management of hypoxic-ischaemic encephalopathy in the therapeutic hypothermia era: a national population study. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2021 Sep 1;106(5):529-34.