Perioperative evaluation of the measurement of the arterio-jugular venous oxygen difference and the use of the free radical scavenger tirilazad mesylate in the management of the severely head injured patients

The aim of this study was to highlight the anesthetist role in dealing with the severely head injured patients, the assessment of the arteriojugular venous oxygen difference as an important parameter in the management of head injured patient and evaluation the role of the tirilazad mesylate in improving the outcome. This study was carried out on 80 adult patients with severe head injury. They were divided into 2 equal groups according to arterio-jugular venous difference in oxygen content [AVDO2]. Then each group was further subdivided into 2 subgroups A and B, subgroups I A and IIA receiving tirilazad mesylate while subgroups IB and IIB received placebo. The incidence of unfavorable outcomes in patients with wide AVDO2 [group I] was significantly higher than in those with normal or narrow AVDO2 [group II]. Unfavorable outcome occurred in 92.6% of the patients who had one or more episodes of hypertension compared with only 41.5% in those who did not. The outcome in patients who suffered a single or multiple episode of raised [ICP] above 20 mmHg was grave compared with those without intracranial hypertension. The present study showed no significant difference between the 4 subgroups as regard cerebral perfusion pressure [CPP]. The study showed that the patients who had hyperglycaemia above 150-mg/ dl had unfavorable outcome compared with those with normoglycaemia. In the present study tirilazed mesylate failed to demonstarte any neuroprotective efficacy in those who received this drug. Retrograde jugular cannulation is a simple technique that should be mastered and implemented by anesthesiologists for jugular oxygenation monitoring to detect the presence or absence of ischemia and hyperemia and consequently can modify his anesthetic plan according to the prevailing condition

Perioperative evaluation of mycocardial function and electrocardiographic changes after subarachnoid hamorrhage

The aim of the present study was to evaluate perioperative myocardial function and electrocardiographic changes of patients after subarachnoid due to ruptured cerebral aneurysm and undergoing an aneurysm clipping procedure. Twenty adult patients scheduled for aneurysm clipping were assessed according to the Hunt and Hess scale.Echocardiography was done in all patients before operation and was repeated on the first postoperative day for patients with initial abnormal findings. Wall motion was assessed by segmental analysis. Wall motion index and left ventricular ejection fraction were determined. Standard twelve lead ECGs were performed daily. Creatinine kinase [CK] and its isozyme [CK-MB] were determined on admission, during the operation and on the first postoperative day. Group Ab were those with initial echocardiographic abnormalities [8 patients] and group N with a normal echocardiographic study [12 patients]. Out of 128 segments in group Ab patients, 16 segments showed moderate hypokinase [12.5%], 8 segments showed severe hypokinesia [6.5%] and 4 segments were akinetic [3%]. Wall motion index and left ventricular ejection fraction did not change before and after surgery in these patients. CK and CK-MB values were initially higher [19.6 +/- 4.6 IU/ L], [P < 0.001] in the Ab group but intra-and postopertively were statistically insignificant. Group Ab patients had a mean neurological grade of 4.1 while those Group N had a mean neurological grade of 1.4, a statistically significant difference. This was accompanied with a worse outcome in the form of permenant disability or death in 75% of cases and mortality in 50% of cases. Left ventricular wall abnormalities are common in patients with anetrysmal subarchonoid haemorrhage. They are associated with ECG abnormalities and myocardial enzyme elevations. They are more common in patients with high neurological grades and are associated with poor outcome and increased mortality