Neurocritical care
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Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm. ⋯ Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
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Case Reports
Methylene blue-associated serotonin syndrome: a 'green' encephalopathy after parathyroidectomy.
Methylene blue (MB) infusion is frequently used to localize the parathyroid glands during parathyroidectomy and generally considered safe. Several recent reports suggest neurological toxicity and post-operative altered mental state typically after large dose infusions. The mechanism by which MB has neurotoxic effects in some patients remains uncertain. ⋯ Methylene blue, when used in patients on antidepressant drugs, may be associated with a transient encephalopathic state and serotonin syndrome. Patients on antidepressants undergoing parathyroidectomy who may receive MB infusion should be considered for alternative parathyroid gland identification or discontinuation of the antidepressants before surgery. MB-associated serotonin syndrome is an increasing and under recognized ('green') post-operative encephalopathy that warrants education to critical care neurologists and other physicians.
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Randomized Controlled Trial
A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients.
To assess whether monitoring sedation status using bispectral index (BIS) as an adjunct to clinical evaluation was associated with a reduction in the total amount of sedative drug used in a 12 h period. ⋯ BIS-augmented sedation monitoring resulted in a marked reduction in the total dose of sedative used to achieve the same level of clinical sedation resulting in shortened time to wake up without any measurable adverse effects. Physiologic sedation assessment tools may provide a useful means of improving the care of sedated critically ill patients.
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Controlled Clinical Trial
Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults.
To study the correlation between a dynamic index of cerebral autoregulation assessed with blood flow velocity (FV) using transcranial Doppler, and a tissue oxygenation index (TOI) recorded with near-infrared spectroscopy (NIRS). ⋯ NIRS shows promise for the continuous assessment of cerebral autoregulation in adults.