Central Nervous System Trauma

Effect of vancomycin infusion on cardiac function in patients scheduled for cardiac operation

Patients scheduled for cardiac operation often receive vancomycin before the operation to decrease postoperative staphylococcal wound infections. In animal studies, vancomycin depressed cardiac function approximately 15%. Because of the potentially serious consequences of myocardial depression in patients undergoing cardiac operation, we examined the effect of vancomycin infusion on cardiac hemodynamics in patients scheduled for cardiac operation. Patients who were scheduled for cardiac operation and vancomycin prophylaxis were enrolled in our study. After baseline cardiac output, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were measured, 1 gm of vancomycin HCl was infused over 1 hour. Cardiac output, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were measured at 15, 30, 60, 90, and 120 minutes after the start of the infusion. In the 46 patients that completed the study, no significant change was observed in cardiac output or systemic vascular resistance at any time when compared with baseline. Mean arterial pressure increased significantly (p = 0.03) between baseline (90.8 +/- 2.4 standard error of mean) and 90 minutes (94.1 +/- 2.4 standard error of mean). One patient had a transient 30% fall in mean arterial pressure and systemic vascular resistance with facial flushing during the infusion. In conclusion, we found that vancomycin infusion over 1 hour in patients before cardiac operation is safe and not associated with cardiac depression.

The adult cervical spine: implications for airway management

Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. Using the Index Medicus as a guide, 30 years of medical literature were reviewed, with emphasis on the last ten years. Key words employed for this review are cited in the manuscript. Relevant papers were selected from anaesthetic, orthopaedic, rheumatologic, emergency medicine and trauma journals and reviewed. Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.