Håndtering af lettere hovedtraumer hos voksne

Præsentationer af emnet: "Håndtering af lettere hovedtraumer hos voksne"— Præsentationens transcript:

1 Håndtering af lettere hovedtraumer hos voksne
DEMC Mads Rasmussen Overlæge Neuroanæstesiologisk afsnit, Anæstesiologisk Afd. Århus Universitetshospital Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP

2 Let hovedtraume: Publikationer
Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 2

3 Let hovedtraume: risiko for alvorlig komplikation
Ca patienter/år……85 % af alle patienter i DK med hovedtraume 2. Commotio cerebri Kortvarigt bevidsthedstab,amnesi, kvalme,opkast Typisk indlagt i 2-3 dage 15% har et kompliceret efterforløb Risiko for alvorlig komplikation = 0.9% Mortalitet = 0.1% Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP Sundhedsvæsenets udfordring ! At finde patienten med behandlingskrævende komplikation ! 3

4 Let hovedtraume: risiko for alvorlig komplikation
Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 4

5 Let hovedtraume: Visitation
Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 5

6 Let hovedtraume: S100B 1. Lavmolekylært protein som findes i astrocytter. 2. Små koncentrationer i CSF og plasma. 3. Kort halveringstid (serumværdi > 6 timer: risiko for falsk negativ værdi) 4. Negativ prædiktiv værdi på > 99% ved Konc < 0.10 ug/l. 5. Ikke valideret til børn. Stort fransk studie indikerer dog at grænseværdi på 0.1 ug/L kan anvendes ned til 15 år SB100-værdi < 0.1 ug/l, taget inden 6 timer efter traume udelukker derfor komplikation og dermed behov for CT af cerebrum Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 6

7 Let hovedtraume: Information til patienter og pårørende
Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 7

8 Let hovedtraume: Hvordan går det på længere sigt
Let hovedtraume: Hvordan går det på længere sigt.. ? En overset patientgruppe !!! 15 % udvikler komplikationer ”post-concussive syndrome” Symptomer: Kognitive (koncentration, hukommelse), Somatiske (hovedpine, træthed), angst Hyppig diagnose i USA (sport, blast injuries) 3. Stigmatiseret og misforstået patientgruppe Endnu intet fast forløb/follow up i DK 4. Ny forskning viser betydelige strukturelle læsioner hos patienter med langtidsfølger efter mild TBI Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 8

9 DTI (diffusion tensor imaging)
highlighted region demonstrating crossing pathways in the cerebral white matter

10 Let hovedtraume: DTI Dear chairman, Ladies &gentlemen
First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 10

11 Let hovedtraume: DTI However In a subsequent randomised study we examined wheter indomethacin would reduce ICP in propofol anaesthetised patients undergoing craniotomy. In this study indomethacin was administered before induction of anaesthesia as a bolus dose followed by an infusion which was terminated after opening of the dura mater. We measured ICP through the first burr hole and again after removal of the boneflap before opening of the dura mater.

12 Let hovedtraume: Konklusion
Der foreligger retningslinjer for akut diagnostik og visitation af patienter med let-moderat hovedtraume En væsentlig andel af patienter med let-moderat hovedtraume udvikler ”post-concussion syndrome” Denne patientgruppe er overset. Der mangler struktureret opfølgning og behandling af disse patienter.. TAK ! Dear chairman, Ladies &gentlemen First I would like to thank the organizing committe for inviting me to talk at this symposium concerning mechamisms of brain dysfunction. My scientific interest is within the field of neuroanaesthesia with the focus on the management of intracranial pressure in patients undergoing craniotomy. In this talk I will show you some data which i hope will show you the importance of intraoperative ICP monitoring and secondly I will talk about the management of high ICP with indomethacin which we at our department consider as a real alternative to the more traditional methods to manage ICP 12