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首页> 外文期刊>Indian journal of Anaesthesia >Research studies that have influenced practice of neuroanesthesiology in recent years: A literature review
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Research studies that have influenced practice of neuroanesthesiology in recent years: A literature review

机译：近年来影响神经麻醉学实践的研究：文献综述

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摘要

Through evolving research, recent years have witnessed remarkable achievements in neuromonitoring and neuroanesthetic techniques, with a huge body of literature consisting of excellent studies in neuroanaesthesiology. However, little of this work appears to be directly important to clinical practice. Many controversies still exist in care of patients with neurologic injury. This review discusses studies of great clinical importance carried out in the last five years, which have the potential of influencing our current clinical practice and also attempts to define areas in need of further research. Relevant literature was obtained through multiple sources that included professional websites, medical journals and textbooks using key words “neuroanaesthesiology,” “traumatic brain injury,” “aneurysmal subarachnoid haemorrhage,” “carotid artery disease,” “brain protection,” “glycemic management” and “neurocritical care.” In head injured patients, administration of colloid and pre-hospital hypertonic saline resuscitation have not been found beneficial while use of multimodality monitoring, individualized optimal cerebral perfusion pressure therapy, tranexamic acid and decompressive craniectomy needs further evaluation. Studies are underway for establishing cerebroprotective potential of therapeutic hypothermia. Local anaesthesia provides better neurocognitive outcome in patients undergoing carotid endarterectomy compared with general anaesthesia. In patients with aneurysmal subarachnoid haemorrhage, induced hypertension alone is currently recommended for treating suspected cerebral vasospasm in place of triple H therapy. Till date, nimodipine is the only drug with proven efficacy in preventing cerebral vasospasm. In neurocritically ill patients, intensive insulin therapy results in substantial increase in hypoglycemic episodes and mortality rate, with current emphasis on minimizing glucose variability. Results of ongoing multicentric trials are likely to further improvise our practice.Keywords: Aneurysmal subarachnoid haemorrhage, brain protection, carotid artery disease, glycemic management, neuroanaesthesiology, neurocritical care, traumatic brain injury
机译：通过不断发展的研究，近年来在神经监测和神经麻醉技术方面取得了令人瞩目的成就，大量的文献包括对神经麻醉学的出色研究。但是，这些工作似乎很少对临床实践直接重要。在神经损伤患者的护理方面仍然存在许多争议。这篇综述讨论了在过去五年中进行的具有重要临床意义的研究，这些研究可能会影响我们目前的临床实践，并试图确定需要进一步研究的领域。通过包括关键词“神经麻醉学”，“颅脑外伤”，“动脉瘤蛛网膜下腔出血，“颈动脉疾病”，“脑保护”，“血糖管理”等关键词的专业网站，医学期刊和教科书等多种来源获得了相关文献。和“神经病护理”。在头部受伤的患者中，胶体和院前高渗盐水的复苏尚无发现，而采用多模式监测，个性化最佳脑灌注压力疗法，氨甲环酸和减压颅骨切除术则需要进一步评估。建立治疗性低温的脑保护潜力的研究正在进行中。与全身麻醉相比，局部麻醉在接受颈动脉内膜切除术的患者中提供更好的神经认知结果。对于患有动脉瘤性蛛网膜下腔出血的患者，目前推荐单独使用诱发性高血压代替三联H疗法来治疗可疑的脑血管痉挛。迄今为止，尼莫地平是唯一可证明具有预防脑血管痉挛功效的药物。在神经重症患者中，强化胰岛素治疗会导致降血糖发作和死亡率大幅增加，目前的重点是最大程度地降低葡萄糖变异性。正在进行的多中心试验的结果可能会进一步改善我们的实践。关键词：动脉瘤性蛛网膜下腔出血，脑保护，颈动脉疾病，血糖管理，神经麻醉学，神经重症监护，创伤性脑损伤

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