Neurological research
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Neurological research · Oct 2007
ReviewA synopsis of brain pressures: which? when? are they all useful?
In addition to intracranial pressure (ICP) and cerebral perfusion pressure (CPP), there are many more brain-related measures defined as 'pressures'. Cerebral intra-tissue pressure, critical closing pressure, 'optimal' CPP, non-invasive CPP (nCPP) and non-invasive ICP (nICP), interhemispherical pressure gradients are the modalities which currently attract more attention in the management of head injured patients. ⋯ Most of the derived brain pressures cannot be assessed at the bedside without a dedicated computer tool. Some practical and theoretical aspects about the measurement, signal analysis, estimation process, accuracy and interpretation need further researching and refinement.
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Neurological research · Oct 2007
ReviewPropofol and barbiturates for the anesthesia of refractory convulsive status epilepticus: pros and cons.
To discuss mainly the use of propofol and barbiturates in the anesthesia of refractory status epilepticus (RSE). ⋯ The use of propofol, barbiturates or midazolam in the anesthesia of RSE can be justified. When using propofol, the duration of high doses should be limited to 48 hours and the risk of propofol infusion syndrome should be kept in mind. High doses of barbiturates terminate effectively seizures but recovery from anesthesia prolongs ventilator treatment and intensive care.
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Alteration of sensorium or an encephalopathy is a common diagnostic dilemma in critically ill patients and can be caused by a number of conditions. Sepsis associated encephalopathy (SAE) is now the most common encephalopathy encountered among intensive care unit (ICU) patients. ⋯ It is important to recognize SAE for its therapeutic and prognostic aspects. SAE worsens morbidity and mortality among ICU patients. Most therapeutic options center around aggressive treatment of the underlying infection.