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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(2):79-82; doi:10.1093/bjaceaccp/mkl007
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 2 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Current controversies in neuroanaesthesia, head injury management and neuro critical care

LD Mishra, MBBS, MD
Reader, Department of Anaesthesiology, Division of Neuroanaesthesia, Institute of Medical Sciences, Banaras Hindu University Varanasi-221005, India Tel: 0091 542 2317140, 0091 94152 66514 Fax: 0091 542 2367384 E-mail: ldmishra@rediffmail.com (for correspondence)

N Rajkumar, MBBS
3rd year resident and MD student, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University Varanasi-221005, India

SM Hancock, FRCA
Consultant Anaesthetist, Department of Anaesthesia, Queen's Medical Centre Derby Road, Nottingham NG7 2UH, UK
The first 150 words of the full text of this article appear below.


Key points

The use of nitrous oxide remains controversial.

Hypothermia has a limited role.

Routine hyperventilation should be avoided.

Blood glucose should be strictly controlled.

Nimodipine and remacemide may improve outcome in certain situations.

 

Despite advances in our understanding of neurosciences, the practice of neuroanaesthesia tends to be based on tradition, and controversies exist regarding the best practice. This article aims to explain some of the more common controversies and, where feasible, reach a consensus, based on recent advances.


   Drugs in neuroanaesthesia
 
Most discussions on neuroanaesthesia generally centre on the effects of drugs and therapeutic manoeuvres on cerebral metabolism (CMRO2), cerebral blood flow (CBF) and intracranial pressure (ICP). Widely accepted anaesthetic goals in patients with intracranial pathology include:

  • To prevent an increase in ICP during induction and maintenance of anaesthesia.
  • To maintain adequate cerebral perfusion pressure (CPP).
  • To avoid interference with cerebral autoregulation.
  • To achieve rapid and smooth induction and emergence from . . . [Full Text of this Article]

Inhalation vs i.v. anaesthesia

Nitrous oxide

Opioids


   Sitting position
 

   Mild hypothermia
 

   Hyperventilation
 

   Induced hypotension
 

   Hypervolaemia, hypertension and haemodilution (triple-H therapy)
 

   Crystalloids vs colloids in head injury
 

   Hypertonic saline, mannitol and steroids
 

   Non-anaesthetic drugs
 

   New techniques
 

   Insulin therapy
 

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