A retrospective observational pilot study on the effects of dexmedetomidine on neurological outcomes after aneurysmal subarachnoid hemorrhage

Esfahani, Kamilla; Lacomis, Christopher D.; Dunn, Lauren K.; Chen, Ching-Jen; Zuo, Zhiyi; Naik, Bhiken I.

doi:10.1016/j.jclinane.2020.110106

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…A recent correspondence from Esfahani et al, [ 49 ] investigating SAH patients who received dexmedetomidine for ICU sedation did not find an association with vasospasm protection or favorable clinical outcomes at discharge as measured by mRS and Glasgow Outcome scale. As noted by the authors, the study was limited by small sample size, non-standardized dexmedetomidine dosing and difference in the clinical severity between the compared groups.…”

Section: Anesthetics/adjuvants In DCI After Sahmentioning

confidence: 99%

“…Several experimental studies show dexmedetomidine provides significant protection against both EBI and DCI following SAH [ 21 , 22 , 47 , 48 ]. A clinical study supports the use of dexmedetomidine in SAH patients as it shows a favorable neurologic outcome [ 50 ] and another study finds no impact on the outcomes [ 49 ]. Benzodiazepines, specifically midazolam has been shown to associate with poor outcomes in SAH patients [ 40 , 51 ].…”

Section: Summary Of Anesthetics/adjuvants and Neurovascular Protection In Sahmentioning

confidence: 99%

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Role of Anesthetics and Their Adjuvants in Neurovascular Protection in Secondary Brain Injury after Aneurysmal Subarachnoid Hemorrhage

Athiraman

Zipfel

2021

IJMS

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Aneurysmal rupture accounts for the majority of subarachnoid hemorrhage and is responsible for most cerebrovascular deaths with high mortality and morbidity. Initial hemorrhage severity and secondary brain injury due to early brain injury and delayed cerebral ischemia are the major determinants of outcomes after aneurysmal subarachnoid hemorrhage. Several therapies have been explored to prevent these secondary brain injury processes after aneurysmal subarachnoid hemorrhage with limited clinical success. Experimental and clinical studies have shown a neuroprotective role of certain anesthetics in cerebrovascular disorders including aneurysmal subarachnoid hemorrhage. The vast majority of aneurysmal subarachnoid hemorrhage patients require general anesthesia for surgical or endovascular repair of their aneurysm. Given the potential impact certain anesthetics have on secondary brain injury after SAH, appropriate selection of anesthetics may prove impactful on overall outcome of these patients. This narrative review focuses on the available evidence of anesthetics and their adjuvants in neurovascular protection in aneurysmal subarachnoid hemorrhage and discusses current impact on clinical care and future investigative directions.

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Section: Anesthetics/adjuvants In DCI After Sahmentioning

confidence: 99%

Section: Summary Of Anesthetics/adjuvants and Neurovascular Protection In Sahmentioning

confidence: 99%

Role of Anesthetics and Their Adjuvants in Neurovascular Protection in Secondary Brain Injury after Aneurysmal Subarachnoid Hemorrhage

Athiraman

Zipfel

2021

IJMS

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The Impact of Sedative Choice in the Management of Aneurysmal Subarachnoid Hemorrhage: A Scoping Review

Then,

Tawfik,

Law

et al. 2024

Neurocrit Care

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Aneurysmal subarachnoid hemorrhage (aSAH) is characterized by high mortality and morbidity. This scoping review assesses the current evidence regarding the use of sedatives and analgesics in the acute intensive care unit management of aSAH. We conducted a systematic search of Ovid MEDLINE, Ovid Embase, Ovid EmCare, APA PsycInfo, CINAHL, and the Cochrane Database of Systematic Reviews from inception to June 2023. Studies were included if they enrolled intensive care unit patients aged 18 or older with a significant proportion (> 20%) who had aSAH and evaluated the impact of one or more commonly used analgosedatives on physiological parameters in the management of aSAH. The methodological quality of the studies was assessed using the Methodological Index for Nonrandomized Studies score. Of 2,583 articles, 11 met the inclusion criteria. The median sample size was 47 (interquartile range 10–127), and the median Methodological Index for Nonrandomized Studies score was 9.5 (interquartile range 8–11). The studies’ publication years ranged from 1980 to 2023. Dexmedetomidine and ketamine showed potential benefits in reducing the incidence of cortical spreading depolarization and delayed cerebral ischemia. Propofol and opioids appeared safe but lacked robust evidence for efficacy. Benzodiazepines were associated with increased delayed cerebral ischemia–related cerebral infarctions and cortical spreading depolarization events. The evidence available to guide the use of analgosedative medications in aSAH is critically inadequate. Dexmedetomidine and ketamine warrant further exploration in large-scale prospective studies because of their potential benefits. Improved study designs with consistent definitions and a focus on patient-centered outcomes are necessary to inform clinical practice.

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A retrospective observational pilot study on the effects of dexmedetomidine on neurological outcomes after aneurysmal subarachnoid hemorrhage

Cited by 2 publications

References 4 publications

Role of Anesthetics and Their Adjuvants in Neurovascular Protection in Secondary Brain Injury after Aneurysmal Subarachnoid Hemorrhage

Role of Anesthetics and Their Adjuvants in Neurovascular Protection in Secondary Brain Injury after Aneurysmal Subarachnoid Hemorrhage

The Impact of Sedative Choice in the Management of Aneurysmal Subarachnoid Hemorrhage: A Scoping Review

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