Sedation in TBI Patients

Peluso, Lorenzo; López, Berta; Badenes, Rafael

doi:10.5772/intechopen.85266

Cited by 5 publications

(7 citation statements)

References 42 publications

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“…In patients who are hypovolemic, PEEP >10 cm H 2 O may reduce CBF. Continuous infusion of sedative and analgesic drugs is beneficial in mechanical ventilated patients for synchronizing of ventilation strategy [11].…”

Section: Hypotensionmentioning

confidence: 99%

“…Patientventilator dyssynchrony and agitation increase intrathoracic pressure, which increase CBV and consequently increase ICP [27]. Ideal sedative drugs should have rapid onset and recovery for a quick neurological assessment, a predictable clearance independent of end organ failure and reducing cerebral blood flow and cerebral metabolic rate of oxygen consumption [11].…”

Section: Sedation and Analgesiamentioning

confidence: 99%

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Management of Traumatic Brain Injury

Htay¹

2022

Trauma and Emergency Surgery

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Head trauma or traumatic brain injury (TBI) is one of the most serious, life-threatening conditions in trauma victims. Prompt and appropriate therapy is essential to obtain a favorable outcome. The aim of the acute care of patients with brain injury is to optimize cerebral perfusion and oxygenation and to avoid secondary brain injury. Secondary brain injury develops with times and cause further damage to nervous tissues. The common denominators of secondary injury are cerebral hypoxia and ischemia. A systemic approach such as the Advanced Trauma Life Support (ATLS) algorithm has been recommended for managing head injury patients. Quick initial assessment of the patient’s neurologic condition thoroughly is mandatory. There should be attention in evidence of intrathoracic or intraperitoneal hemorrhage in multiple traumatized patients. Optimizing the open airway and adequate ventilation depending on patient’s neurologic condition is first step in emergency therapy. Cerebral perfusion pressure should be maintained between 50 and 70 mmHg. Systemic hypotension is one of the major contributors to poor outcome after head trauma. Careful stabilization of the blood pressure with fluid resuscitation and a continuous infusion of an inotrope or vasopressor may be necessary. Standard monitoring with direct arterial blood pressure monitoring and periodical measurement of arterial blood gases, hematocrit, electrolytes, glucose, and serum osmolarity are important. Brain monitoring as with an electroencephalogram, evoked potentials, jugular venous bulb oxygen saturation (Sjo2), flow velocity measured by transcranial Doppler (TCD), brain tissue oxygenation (btPo2), and ICP monitoring may be used. The reduction of elevated ICP by means of giving barbituates, hyperventilation, diuretics and hyperosmolar fluid therapy, body posture and incremental CSF drainage are critical. Seizure prophylaxis, early enteral feeding, stress ulcer prophylaxis, prevention of hyperglycemic state, fever and prophylaxis against deep venous thrombosis in neurointensive care unit are also important after successful resuscitation of head trauma patients.

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Section: Hypotensionmentioning

confidence: 99%

Section: Sedation and Analgesiamentioning

confidence: 99%

Management of Traumatic Brain Injury

Htay¹

2022

Trauma and Emergency Surgery

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“…In high‐resource settings, remifentanil is seen as an ideal short‐acting drug for sedation in patients with TBI due its predictability and ultra‐short duration which allows timely neurological evaluation [23]; however, it is costly and often unavailable. Morphine and pethidine can form active metabolites which can hinder neurological assessment and can also precipitate seizures, hence high doses are not ideal for sedation in patients with TBI [14,15], but in low‐resources settings, due to low cost, ready availability and lack of alternatives, they are often used intermittently via intramuscular or i.v. routes.…”

Section: Choice Of Sedative Drugsmentioning

confidence: 99%

“…Hypoxia and ischaemia underlie much of the secondary brain injury, leading to cell apoptosis, cerebral swelling, diffuse axonal injury and inflammation [12, 13]. The secondary brain injury can be caused or exacerbated by arterial hypotension, hypertension, hypoxaemia, intracranial haemorrhage, brain oedema, fever, seizures, hypo‐ and hyperglycaemia, and hyper‐ and hypocapnia [14, 15]. As the primary brain injury is essentially irreversible, care focuses on preventing or limiting secondary brain injuries [15].…”

Section: Introductionmentioning

confidence: 99%

Pragmatic sedation strategies to prevent secondary brain injury in low‐resource settings

2022

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Summary Traumatic brain injury is the alteration in brain function due to an external force. It is common and affects millions of people worldwide annually. The World Health Organization estimates that 90% of global deaths caused by injuries occur in low‐ and middle‐income countries, with traumatic brain injury contributing up to half of these trauma‐related deaths. Patients with traumatic brain injury in low‐ and middle‐income countries have twice the odds of dying compared with their counterparts in high‐income countries. Sedation is a key element of care in the management of traumatic brain injury, used for its neuroprotective effects and to prevent secondary brain injury. While sedatives have the potential to improve outcomes, they can be challenging to administer and have potentially dangerous complications. Sedation in low‐resource settings should aim to be effective, safe, affordable and feasible. In this paper, we summarise the indications for sedation in traumatic brain injury, the choice of sedative drugs and the pragmatic management and monitoring of sedated traumatic brain injury patients in low‐resource settings.

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“…TBI patients need to go through anesthesia for various reasons such as prevention of seizures, pharmacological sedation, and surgery ( 14 , 15 ). In clinical TBI, sedation through drugs still remains the first line of treatment to prevent further complications, normalize intracranial pressure (ICP), and reduce metabolic demand ( 14 , 16 ). Generally, the choice of anesthetic agents is decided by the treating physician based on the drug's hemodynamic factors, its ability to reduce ICP, cerebral metabolic rate, and the drug's potential to cause short-term and long-term side effects ( 15 , 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Are GABAergic drugs beneficial in providing neuroprotection after traumatic brain injuries? A comprehensive literature review of preclinical studies

Sudhakar¹

2023

Front. Neurol.

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Traumatic brain injuries (TBI) caused by physical impact to the brain can adversely impact the welfare and well-being of the affected individuals. One of the leading causes of mortality and dysfunction in the world, TBI is a major public health problem facing the human community. Drugs that target GABAergic neurotransmission are commonly used for sedation in clinical TBI yet their potential to cause neuroprotection is unclear. In this paper, I have performed a rigorous literature review of the neuroprotective effects of drugs that increase GABAergic currents based on the results reported in preclinical literature. The drugs covered in this review include the following: propofol, benzodiazepines, barbiturates, isoflurane, and other drugs that are agonists of GABAA receptors. A careful review of numerous preclinical studies reveals that these drugs fail to produce any neuroprotection after a primary impact to the brain. In numerous circumstances, they could be detrimental to neuroprotection by increasing the size of the contusional brain tissue and by severely interfering with behavioral and functional recovery. Therefore, anesthetic agents that work by enhancing the effect of neurotransmitter GABA should be administered with caution of TBI patients until a clear and concrete picture of their neuroprotective efficacy emerges in the clinical literature.

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Sedation in TBI Patients

Cited by 5 publications

References 42 publications

Management of Traumatic Brain Injury

Management of Traumatic Brain Injury

Pragmatic sedation strategies to prevent secondary brain injury in low‐resource settings

Are GABAergic drugs beneficial in providing neuroprotection after traumatic brain injuries? A comprehensive literature review of preclinical studies

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