Total Intravenous Anesthesia Including Ketamine versus  Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury

Abstract

Total intravenous anesthesia often including ketamine was not associated with improved neurologic outcome compared with VGA. Multiple confounders limit conclusions that can be drawn from this retrospective study.

Target-controlled Infusion Propofol Versus Sevoflurane Anaesthesia for Emergency Traumatic Brain Surgery: Comparison of the Outcomes

“…The percentage of good outcomes (GOS 4-5: moderately disabled to good recovery) was also comparable between the two groups (43.6% versus 41.8%). The only available study that investigated the effect of anaesthetic technique on neurological outcomes after TBI was a retrospective study by Grathwohl et al on combat-related TBI (9). Good neurologic outcomes (GOS 4-5) and decreased mortality were more significantly associated with TIVA than with inhalational anaesthesia (75% versus 54% and 5% versus 16%, respectively).…”

“…The sample size was calculated using PS Power and Sample Size Calculations software, Version 3.0, based on a previous study by Grathwohl et al that showed significant differences (75% versus 54%) in good neurological outcomes (GOS 4-5) between TIVA and inhalational anaesthesia (9). With an expected improvement of 20%, power of study of 80%, alpha of 0.05 and expected dropout rate of 10%, for each group 55 samples were calculated (total samples 110).…”

Traumatic Brain Injury and Increased Intracranial Pressure

“…TBI affects approximately 1.4 million individuals annually in the United States and carries annual health care costs that exceed $100 billion. 2 TBI is associated with 50% of all trauma-related deaths leading to refractory intracranial hypertension and herniation. 3 Additionally, one-third of the deaths associated with Operation Iraqi Freedom and the Vietnam conflict were caused by TBI.…”

“…Secondary brain injuries significantly increase with episodic hypotension, increased intracranial pressure and hypoxia, 4 leading to neuronal death from cerebral edema, ischemia, and acute inflammation. 2 Secondary brain injuries are associated with increased rates of mortality and long-term disability. For every person who dies from a trauma-related injury, three are permanently disabled.…”

“…3 Additionally, one-third of the deaths associated with Operation Iraqi Freedom and the Vietnam conflict were caused by TBI. 2 Perianesthesia nurses working in facilities with a trauma center designation are on the front line to deliver care to critically ill patients with severe TBI. Secondary brain injuries significantly increase with episodic hypotension, increased intracranial pressure and hypoxia, 4 leading to neuronal death from cerebral edema, ischemia, and acute inflammation.…”