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An Italian survey of severe head trauma management during extracranial surgery

Published online by Cambridge University Press:  19 April 2005

N. Latronico ,
A. Chieregato ,
F. Rasulo ,
S. Piva ,
E. Zei ,
F. Procaccio ,
M. Gemma ,
L. Beretta  and
L. Targa
N. Latronico
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
A. Chieregato
Affiliation:
Servizio di Anestesia e Rianimazione, Ospedale Maurizio Bufalini, Cesena, FO, Italy
F. Rasulo
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
S. Piva
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
E. Zei
Affiliation:
U.O. di Neuroanestesia, Policlinico Le Scotte, Siena, Milano, Italy
F. Procaccio
Affiliation:
U.O. Anestesia e Rianimazione, Dipartimento di Neurochirurgia, Ospedale Maggiore, Verona, Italy
M. Gemma
Affiliation:
Servizio di Neurorianimazione, Ospedale San Raffaele, Milano, Italy
L. Beretta
Affiliation:
Servizio di Neurorianimazione, Ospedale San Raffaele, Milano, Italy
L. Targa
Affiliation:
Servizio di Anestesia e Rianimazione, Ospedale Maurizio Bufalini, Cesena, FO, Italy
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Abstract

Summary

Background and objective: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic.

Methods: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products.

Results: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport.

Conclusions: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.

Keywords

HEAD INJURIES, closedBRAIN TRAUMA, acute, secondaryANAESTHESIAHEALTHCARE SURVEYINTRACRANIAL PRESSUREHAEMODYNAMIC PHENOMENA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 227 - 232
Copyright
2005 European Society of Anaesthesiology

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References

Marmarou A, Anderson RL, Ward JD, et al. Impact of ICP instability and hypotension onoutcome in patients with severe head trauma. J Neurosurg 1991; 75: S59–S66.Google Scholar
Ricard-Hibon A, Marty J. Management of severe head-injured patients in the first 24 hours. Resuscitation and initial diagnostic strategy. Ann Fr Anesth Reanim 2000; 19: 286–295.Google Scholar
Grande CM, Barton CR, Stene JK. Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg 1988; 67: 714–715.Google Scholar
Wald S, Fenwick J, Shackford SR. The effect of secondary insults on mortality and long-term disability of severe head injury in a rural region without a trauma system. J Trauma 1991; 34: 377–381.Google Scholar
The Brain Trauma Foundation. The American Association of Neurological Surgeons: The Joint Section on Neurotrauma and Critical Care. Hypotension. J Neurotraum 2000; 17: 591–595.
Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The executive committee of the international selfotel trial. J Neurosurg 2000; 92: 1–6.Google Scholar
Latronico N, Marino R, Rasulo F, Stefini R, Schembari M, Candiani A. Bedside burrhole for intracranial pressure monitoring performed by anaesthetist intensive care physicians. Extending the practice to the entire ICU team. Minerva Anestesiol 2003; 69: 159–168.Google Scholar
Ko K, Conforti A. Training protocol for intracranial pressure monitor placement by nonneurosurgeons: 5-year experience. J Trauma 2003; 55: 480–483.Google Scholar
Harris CH, Smith RS, Helmer SD, Gorecki JP, Rody RB. Placement of intracranial pressure monitors by non-neurosurgeons. Am Surg 2002; 68: 787–790.Google Scholar
Macmillian CSA, Andrews PJD. Cerebrovenous oxygen saturation monitoring: practical consideration and clinical relevance. Intensive Care Med 2000; 26: 1028–1036.Google Scholar
Chieregato A, Calzolari F, Trasforini G, Targa L, Latronico N. Normal jugular bulb oxygen saturation. J Neurol Neurosurg Psychiat 2003; 74: 784–786.Google Scholar
Latronico N, Beindorf AE, Rasulo FA, et al. Limits of intermittent jugular bulb oxygen saturation monitoring in the management of severe head trauma patients. Neurosurgery 2000; 46: 1131–1138.Google Scholar
Marion DW, Puccio A, Wisniewski SR, et al. Effects of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Crit Care Med 2002; 30: 2619–2625.Google Scholar
Letarte PB, Puccio AM, Brown SD, Marion DW. Effect of hypocapnea on CBF and extracellular intermediates of secondary brain injury. Acta Neurochir (Wien) 1999; 75: 45S–47S.Google Scholar
Diringer MN, Videen TO, Yundt K, et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 2002; 96: 103–108.Google Scholar
Coles JP, Minhas PS, Fryer TD, et al. Effects of hyperventilation on cerebral blood flow in traumatic head injury. Clinical relevance and monitoring correlates. Crit Care Med 2002; 30: 1950–1959.Google Scholar
The Brain Trauma Foundation. The American Association of Neurological Surgeons: The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotraum 2000; 17: 513–520.
Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990; 30: 933–940.Google Scholar
Enevoldsen EM, Jensen FT. Autoregulation and CO2 response of cerebral blood flow in patients with acute severe head injury. J Neurosurg 1978; 48: 689–703.Google Scholar