Induced hypothermia and fever control for prevention and treatment of neurological injuries

[Survey of anesthesiologists' practice in treating spontaneous aneurysmal subarachnoid hemorrhage]

OBJECTIVES

To evaluate the participation of Spanish anesthesiology departments in the management of patients hospitalized for spontaneous aneurysmal subarachnoid hemorrhage.

MATERIAL AND METHODS

Chiefs of anesthesiology departments of hospitals listed in the Spanish National Catalog of Hospitals of the Ministry of Health and Consumer Affairs were sent a questionnaire with 30 items covering protocols for the management of patients with spontaneous aneurysmal subarachnoid hemorrhage. Items asked about the participation of anesthesiologists during both admission and the perioperative period.

RESULTS

The questionnaire was sent to 132 hospitals, of which 18 (13.6%) responded. Forty-six percent of anesthesiology departments do not participate in the initial resuscitation. Only 4 reported having a protocol for treating these patients. The initial diagnosis was reportedly made by cranial computed tomography in all cases. Endovascular treatment was the most common procedure reported (66%) and it was given within the first 48 hours (66%). Basic monitoring was used more than nervous system monitoring. Total intravenous anesthesia was used for craniotomy in 53% of the hospitals and for endovascular treatment in 64%. Complications reported most often were vasospasm (100%) and hydrocephalus (69%).

CONCLUSIONS

Even though few questionnaires were returned, the results reveal scarce use of protocols for the treatment of spontaneous aneurysmal subarachnoid hemorrhage by anesthesiologists. It was also evident that the participation of anesthesiology department staff in the treatment of this condition takes place almost exclusively in the intraoperative period and that the use of nervous system monitoring is scarce. Endovascular treatment is increasing in our practice settings.

Acute brain injury and therapeutic hypothermia in the PICU: A rehabilitation perspective

Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and reason for admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation.

Therapeutic hypothermia for cardiac arrest: a practical approach

Therapeutic hypothermia (TH), which prevents and ameliorates the cascade of secondary neurologic injury after the return of spontaneous circulation, is the most effective neuroprotective therapy for encephalopathic survivors of cardiac arrest. Acute management of patients with severe hypoxic-ischemic encephalopathy requires rapid and well-coordinated efforts involving emergency medicine, neurology, cardiology, critical care medicine, and palliative care. This effort is complex, and broad implementation of TH has been slow in the United States and Europe. This review summarizes recent developments in the practical application of TH, reviews the role of the neurologist, and suggests an algorithm for coordination of care of cardiac arrest survivors by physicians of divergent subspecialties, with the goals of maximizing neurologic and cardiac recovery.