Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence

Abstract

Defining optimal hemodynamic targets for brain-injured patients is a challenging undertaking. The physiological interference observed in various intracranial pathologies can have varying effects on cerebral physiology at different time points. This narrative review provides an overview of cerebral autoregulatory physiology and common misconceptions, and examines the physiological considerations and clinical evidence for determining optimal hemodynamic parameters in acutely brain-injured patients with relevance to modern neuroanesthesia and neurocritical care practice.

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

“…In patients with aSAH, blood pressure control initially presents a Scylla and Charybdis dilemma: leaving the patient with untreated high blood pressure increases the risk of rebleeding, but lowering blood pressure increases the risk of DCI (Stienen et al, 2018). The importance of striking a balance between the prevention of rebleeding and the avoidance of secondary cerebral ischemia is highlighted, especially during the initial treatment (Ma and Bebawy, 2022). However, there is disagreement about the target blood pressure threshold (Steiner et al, 2013;Minhas et al, 2022).…”

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

“…56,57 The final one was on optimal hemodynamic parameters for brain-injured patients in the clinical setting. 58 Other interesting reviews include opioid alternatives in spine surgery, the effects of anesthesia on glioma progression and cardiac-cerebral coupling. [59][60][61] Finally, there are the recent clinical practice guidelines from the Society for Neuroscience in Anesthesiology and Critical Care on Perioperative care of patients undergoing major complex spinal instrumentation surgery, and the guideline from the American Heart Association/American Stroke Association on the management of patients with spontaneous intracerebral hemorrhage.…”

Perioperative Management for Complex Spine Fusion Surgery

“…Specifically, there are some high-quality prospective and randomized studies supporting the use of erector spinae blocks in thoracolumbar surgery, with promising data emerging for other cervical and truncal fascial plane blocks (including multifidius cervicis blocks, intersemispinal plane blocks, thoracolumbar interfascial plane blocks, and quadratus lumborum blocks, among others). 56,57 While an exhaustive description of these various regional techniques lies outside of the scope of this review, this is an area that holds great potential within the perioperative care of complex spine surgery patients, becoming part of standard care pathways and algorithms in some institutional practices.…”