Articles: trauma.
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The impetus for cerebral hemodynamic monitoring in neurotrauma first arose from the original "talk and die" studies which described the group of head injured patients "who talk and then subsequently died". At necropsy, hypoxic or ischaemic brain damage was observed in a variable proportion of patients raising the possibility that systemic or cerebral hypoxia post trauma may have contributed to the poor neurological outcome. Improved understanding of the pathophysiology of neurotrauma influenced clinical practice in two ways: a) there was a plethora of monitoring modalities developed for evaluating cerebral hemodynamics and oxygenation and b) squeezing oxygenated blood through a swollen brain became the cornerstone of therapy in patients with head injury. ⋯ Although initial monitoring was largely confined to global indices of brain oxygenation, refinement in technology has made the measurement of oxygen tensions further down in the oxygen cascade at the level of the tissue possible and applicable by the bedside. Metabolic monitoring of the brain is now possible with the use of a variety of biochemical indices and with the availability of microdialysis. The purpose of this review is to examine the various modes of monitoring cerebral oxygenation, critically review the literature concerning their use in day to day intensive care practice, outline their limitations and define possible indications for their use.
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Anesthesia and analgesia · Aug 2005
Review Meta AnalysisRevising a dogma: ketamine for patients with neurological injury?
We evaluated reports of randomized clinical trials in the perioperative and intensive care setting concerning ketamine's effects on the brain in patients with, or at risk for, neurological injury. We also reviewed other studies in humans on the drug's effects on the brain, and reports that examined ketamine in experimental brain injury. In the clinical setting, level II evidence indicates that ketamine does not increase intracranial pressure when used under conditions of controlled ventilation, coadministration of a gamma-aminobutyric acid (GABA) receptor agonist, and without nitrous oxide. Ketamine may thus safely be used in neurologically impaired patients. Compared with other anesthetics or sedatives, level II and III evidence indicates that hemodynamic stimulation induced by ketamine may improve cerebral perfusion; this could make the drug a preferred choice in sedative regimes after brain injury. In the laboratory, ketamine has neuroprotective, and S(+)-ketamine additional neuroregenerative effects, even when administered after onset of a cerebral insult. However, improved outcomes were only reported in studies with brief recovery observation intervals. In developing animals, and in certain brain areas of adult rats without cerebral injury, neurotoxic effects were noted after large-dose ketamine. These were prevented by coadministration of GABA receptor agonists. ⋯ Ketamine can be used safely in neurologically impaired patients under conditions of controlled ventilation, coadministration of a {gamma}-aminobutyric acid receptor agonist, and avoidance of nitrous oxide. Its beneficial circulatory effects and preclinical data demonstrating neuroprotection merit further animal and patient investigation.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi · Aug 2005
Review[Advances of functional electrical stimulation in treatment of peripheral nerve injuries].
To review the advances of functional electrical stimulation (FES) in treatment of peripheral nerve injuries. ⋯ FES is an effective treatment for peripheral nerve injuries.
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This study evaluated the ability of a novel intraoperative neurophysiologic monitoring method used to locate the axillary nerve, predict relative capsule thickness, and identify impending injury to the axillary nerve during arthroscopic thermal capsulorrhaphy of the shoulder. ⋯ Level II, prospective cohort study.
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Comparative Study
Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery.
Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. ⋯ US instruments may be safer than ES for dissection close to nerves.