Abstract
Background and objective: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic. Methods: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products. Results: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport. Conclusions: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.
| Original language | English |
|---|---|
| Pages (from-to) | 227-232 |
| Number of pages | 6 |
| Journal | European Journal of Anaesthesiology |
| Volume | 22 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2005 |
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Keywords
- Anaesthesia
- Brain Trauma, acute, secondary
- Haemodynamic Phenomena
- Head Injuries, closed
- Healthcare Survey
- Intracranial Pressure
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
Cite this
An Italian survey of severe head trauma management during extracranial surgery. / Latronico, Nicola; Chieregaro, A.; Rasulo, F.; Piva, S.; Zei, E.; Procaccio, F.; Gemma, M.; Beretta, L.; Targa, L.
In: European Journal of Anaesthesiology, Vol. 22, No. 3, 03.2005, p. 227-232.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An Italian survey of severe head trauma management during extracranial surgery
AU - Latronico, Nicola
AU - Chieregaro, A.
AU - Rasulo, F.
AU - Piva, S.
AU - Zei, E.
AU - Procaccio, F.
AU - Gemma, M.
AU - Beretta, L.
AU - Targa, L.
PY - 2005/3
Y1 - 2005/3
N2 - Background and objective: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic. Methods: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products. Results: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport. Conclusions: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.
AB - Background and objective: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic. Methods: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products. Results: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport. Conclusions: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.
KW - Anaesthesia
KW - Brain Trauma, acute, secondary
KW - Haemodynamic Phenomena
KW - Head Injuries, closed
KW - Healthcare Survey
KW - Intracranial Pressure
UR - http://www.scopus.com/inward/record.url?scp=18844451983&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=18844451983&partnerID=8YFLogxK
U2 - 10.1017/S0265021505000396
DO - 10.1017/S0265021505000396
M3 - Article
C2 - 15852997
AN - SCOPUS:18844451983
VL - 22
SP - 227
EP - 232
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
SN - 0265-0215
IS - 3
ER -