Minerva anestesiologica
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Cerebral ultrasound is a developing point of care tool for intensivists and emergency physicians, with an important role in the diagnosis of acute intracranial pathology, such as the assessment of cerebrovascular diseases and in the noninvasive intracranial pressure measurement both in the acute clinical settings and in intensive care unit (ICU). The traditional application of transcranial doppler (TCD) by assessing blood flow velocities in the main cerebral arteries, allows the evaluation and follow up of cerebral vasospasm, cerebral perfusion pressure, cerebral autoregulation and intracranial hypertension. The use of TCD, traditionally limited to the neurosonology laboratories settings, has expanded over the last years following the introduction of B-mode ultrasound and color Doppler, the transcranial color-coded duplex ultrasonography (TCCS), opening a new window to the assessment of cerebral anatomy not only in the neurocritical patients, but also in general ICU and emergency room patients. Here we report a brief review with the intent to up-to-date and describe the main applications and use of TCD/TCCS in the setting of Neurointensive Care.
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Minerva anestesiologica · Mar 2020
ReviewBenefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring. Light and shadow.
Numerous clinical conditions that have a direct effect on electroencephalography (EEG) cerebral function could also directly influence brain function monitors (BFM) indices. There is no conventional comparator technology for BFM assessment. The conventional comparator technology used as a benchmark for assessing BFMs technologies chosen by the UK National Institute for Health and Care Excellence (NICE) to reflect the currently used standards in the National Health Service (NHS), was demarcated as "standard anesthetic clinical monitoring" and precisely defined as "the combination of routine clinical observation and electronic monitoring used in clinical practice to assess the adequacy of anesthesia." Because BFMs are EEG-derived parameters, all conditions that can "alter" the raw EEG signal would subsequently change BFM indices to reflect other unrelated EEG events of patient-dependent pathophysiologic perturbations. ⋯ Changes in BFM indices during acute cerebral pathology would be highly beneficial to trained informed clinicians as it alerts to something they would not otherwise be aware was happening. This fact-based, citation-supported, narrative review article provides better understanding of BFMs' limitations through examining various published reports of all values that did not coincide with a "standard anesthetic clinical monitoring" whether arising from an underlying alteration of patients' own EEG or those due to shortcomings in the BFM design or performance. The notion of just "riding the numbers" seems to be not a good anesthesia practice; rather we should interpret these BFM indices within context and limitations.
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Minerva anestesiologica · Mar 2020
Observational StudyElevation in optic nerve sheath diameter due to the pneumoperitoneum and Trendelenburg is associated to postoperative nausea, vomiting and headache in patients undergoing laparoscopic hysterectomy.
Optic nerve sheath diameter (ONSD) measurement with ultrasound has emerged as a simple, non-invasive and reliable surrogate of invasive intracranial pressure (ICP) measurement. Increase in ICP might lead to postoperative nausea and vomiting (PONV) and postoperative headache. Here, we aimed to evaluate the extent of change in ONSD, resulting from pneumoperitoneum (PP) and Trendelenburg (TP) position during the laparoscopic hysterectomy (LH), by using ultrasonographic ONSD measurement. We also aimed to investigate the relation of ONSD with PONV and postoperative headache. ⋯ Combination of PP and TP leads to a significant increase in ONSD during LH. The extent of the increase in ONSD during the procedure is significantly correlated with PONV and headache occurring within the first three hours of recovery.