Effect of magnesium -lidocaine combination on outcome after severe head injury

Neuroprotection in the setting of severe head injury [SHI] remains unsettled problem. Our aim was to evaluate the efficacy and safety of a high dose magnesium and low dose lidocaine infused, over 3 days after SHI. Sixty adult patients with SHI [Glasgow Coma Scale

Effect of amino acids infusion on thermoregulatory response and blood loss during spinal anesthesia

Intravenous amino acids infusion during general anesthesia prevents decreases in core temperature resulting from increased energy expenditure and heat accumulation. Mild hypothermia may increase surgical bleeding. We studied the effect of amino acids infusion on changes in core temperature and blood loss during spinal anesthesia in patients undergoing hip surgery. Fifty patients were divided into two equal groups. Group 1 patients received an amino acids infusion at a rate of 2 ml /kg/ hr., corresponding to 4kjkg-1h-1, started 1 hr before spinal anesthesia and two hours during surgery. Group 2 patients received normal saline for the same period. Mean blood pressure, heart rate, tympanic membrane core temperature, forearm-fingertip temperature gradient and mean skin temperature, coagulations profile were monitored during the study period and blood loss was measured. Changes in mean arterial pressure and heart rate did not differ significantly between the two groups during the study period. Mean final core temperature 120 min. after induction of spinal anesthesia was 34.37 [SD 0.37] °C in the saline group and 36.02 [SD 0.21]°C in the amino acid group [p < 0.05] The thermal vasoconstriction threshold was increased in the amino acid group [36.1 +/- 0.1 °C] compared with the saline group [34.0 +/- 0.1 °C]. Blood loss during surgery was significantly larger in the saline group [704.88 +/- 175.9 ml] than in the amino acids group [553.2 +/- 107.14] [p < 0.05]. Platelet counts decreased significantly in both groups immediately and first day after surgery [p < 0.05]. However, there were no differences in coagulation values between the two groups. The amino acids infusion before and during spinal anesthesia was able to prevent the occurrence of intraoperative hypothermia and reduces blood loss without significant effect on coagulation profile

S100-beta and cytokines as early markers to predict outcome after moderate head injury

The aim of this study was to evaluate the potential role of S-100[beta] protein, 1L-1[beta], IL-6 and TNF-alpha as early predictive markers of the severity and outcome after moderate head injury. Twenty-four patients with moderate head injury with Glasgow Coma Scale score "GCS score" [9-12], who, required admission to the intensive care Unit[ICU] were included in this study. Routine ICU monitoring was applied e. g. heart rate, mean blood pressure, continuous ECG, capnography, SaO[2], and CVP. Parameters assessed included GCS at admission, 30 minutes, 60 minutes, 4 hours and then every 12 hours till the end of the study. Ten ml of blood was taken from the internal jugular cannula and another ten mil from the radial artery cannula at admission then at 24, 48, 72 hours for analysis of S-100[beta] protein and interleukin-1 beta;, interteukin-6 and tumour necrosis factor-alpha. A single venous blood sample was taken from 24 healthy volunteers to be considered as a control for the laboratory work. The serum concentrations of S-100[beta] protein, IL-1[beta] IL-6 and TNF-alpha were found to be significantly increased in the arterial and the venous samples at admission, then gradually declines over the next three days with management suggesting that there is a significant brain release of S-100[beta], IL-1[beta], IL-6 and TNF alpha with head injury. The jugular venous concentrations were significantly higher than the arterial concentration all over the time of the study. There were significant inverse correlations between GCS score and both arterial and venous concentrations of S-100[beta] and IL-6 throughout the study period. Also, there were significant inverse correlations between aterial venous concentrations of interleukin-1 beta, TNf -alpha and GCS score at admission and at 24 hours and this correlations became insignificant thereafter. The present study has demonstratred that S-100[beta], interleukin-1 [beta], and tumor- necrosis factor-alpha were increased after head injury. However, S-100 [beta] and interleukin-6 appeared to be the most sensitive predictors and their significant correlations with GCS score make them helpful as prognostic tools in assessing the severity and predicting the outcome after moderate head trauma