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

ABSTRACT

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