Dheeraj Masapu

A comparative study of midazolam and target-controlled propofol infusion in the treatment of refractory status epilepticus

Background: The recommended treatment for refractory status epilepticus (RSE) is the use of anesthetic agents, but evidence regarding the agent of choice is lacking. This study was designed to compare target-controlled infusion of propofol versus midazolam for the treatment of RSE regarding seizure control and complications. Methods: This prospective, randomized study recruited 23 adult patients with RSE due to any etiology and treated with either propofol or midazolam titrated to clinical seizure cessation and gradual tapering thereafter. The primary outcome measure was seizure control and the secondary outcomes were duration of the Intensive Care Unit stay and duration of mechanical ventilation, occurrence of super RSE (SRSE), and complications. Results: We recruited 23 patients (male:female = 18:5) into this study (propofol Group-11; midazolam Group-12). Overall, seizure control was noted in 34.8%, with successful seizure control in 45% of patients in the propofol group and 25% in midazolam group (P = 0.4). Mortality was similar in both the groups (propofol group [8/11; 72.7%] compared to the midazolam group [7/12; 58.3%] [P = 0.667]). The duration of hospital stay was significantly shorter in the propofol group compared to midazolam (P = 0.02). The overall incidence of SRSE was 69.5% in this study. The complication rate was not significantly different between the groups. Conclusions: The choice of anesthetic agent does not seem to affect the overall outcome in RSE and SRSE. Target-controlled propofol infusion was found to be equal in its efficacy to midazolam for the treatment of RSE. High mortality might be due to SRSE secondary to the underlying brain pathology.

Pneumothorax, Pneumomediastinum, and Pneumorrhachis: A Rare Presentation in a Neurological Patient.

Pneumomediastinum, and Pneumorrhachis: A Rare Presentation in a Neurological Patient To JNA Readers: Occurrence of pneumothorax with associated presence of air in the mediastinum, pericardium, and spinal canal is a rare entity seen in neuroanesthetic and neurocritical care practice. We describe a neurological patient with these clinical manifestations and discuss the possible factors contributing to this uncommon complication. An 18-year-old male patient presented with history of headache and vomiting. A computed tomography of the brain showed a hyperdense lesion in the brainstem. Magnetic resonance

Intraoperative aberrant bispectral index values due to facial nerve monitoring

Bispectral index is an accepted depth of anaesthesia monitor for guiding intraoperative hypnotic agent administration. Frontalis EMG displayed on BIS monitor may increase due to twitching of frontalis muscle. EMG increases are also known to cause artefactual increases in BIS values. We report a case of artefactual increase of EMG and subsequently BIS values, due to electrical artefact from cranial nerve stimulator being used to identify the facial nerve. An explanation of the effect of stimulator signal on BIS EMG and BIS values has been provided.

Adverse Hemodynamic Event Due to Floseal Hemostatic Matrix Application.

after 20 minutes was found to be 3.8% of the baseline. We theorized that the remaining ICG caused small decreases of SctO2 to be hidden and thus, pseudonormal values were displayed. Although further studies are required to quantify the effect of the remaining ICG on SctO2 to prove clinical significance of this finding, it would be wise to use multimodality monitoring to monitor functional aspect of neurons (EEG, evoked potentials) along with NIRS-based SctO2 when ICG administration is planned.

Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study

Background: Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome. Methods: Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube. Results: The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay. Conclusions: In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.