British journal of anaesthesia
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Cerebral ischaemia is implicated in poor outcome after brain injury, and is a very common post-mortem finding. The inability of the brain to store metabolic substrates, in the face of high oxygen and glucose requirements, makes it very susceptible to ischaemic damage. ⋯ With the increasing use of multi-modal monitoring, the complex pathophysiology of the injured brain is slowly being unravelled, emphasizing the heterogeneity of the condition, and the requirement for individualization of therapy to prevent secondary adverse hypoxic cerebral events. Brain tissue oxygen partial pressure (Pb(O2) monitoring is emerging as a clinically useful modality, and this review examines its role in the management of brain injury.
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Cerebral microdialysis is a well-established laboratory tool that is increasingly used as a bedside monitor to provide on-line analysis of brain tissue biochemistry during neurointensive care. This review describes the principles of cerebral microdialysis and the rationale for its use in the clinical setting, including discussion of the most commonly used microdialysis biomarkers of acute brain injury. Potential clinical applications are reviewed and future research applications identified. Microdialysis has the potential to become an established part of mainstream multi-modality monitoring during the management of acute brain injury but at present should be considered a research tool for use in specialist centres.
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Perioperative risk of death after general surgery is quoted as overall less than 1%. However, each individual's risk varies widely according to many identified factors with some having a significantly increased risk of a worse outcome. ⋯ This may be in part because of a lack of experience with the practicalities of perioperative optimization, and lack of knowledge in applying currently available tools. This article aims to try and address this deficit and increase awareness of how and when to utilize monitoring equipment to achieve optimal results for the patients we treat.