Use of vasopressors to raise cerebral perfusion pressure in head injured patients.

Cerebral ischemia due to low cerebral perfusion pressure (CPP) is the most important secondary effect of severe head injury. There is consensus regarding the maintenance of this pressure at levels above 70 mm Hg. One way to elevate CPP is by increasing mean arterial pressure (MAP). In this study, the authors attain this target by using adrenergic vasopressors investigating the effectiveness of dopamine, noradrenaline and methoxamine in 16 severe head injured patients. The results were: a) the increase of MAP effectively increased CPP without changes in intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2); b) noradrenaline at a dose of 0.5 mg to 5 mg/h was effective and safe and might be considered the drug of choice; c) dopamine was not as effective at a high dose of 10 to 42.5 micrograms/kg/min; d) methoxamine given as a bolus was an effective way to control sudden decreases in MAP. It made the patients more responsive to dopamine. No important undesirable reactions occurred during the study.

Tolerance, safety and efficacy of Hedera helix extract in inflammatory bronchial diseases under clinical practice conditions: a prospective, open, multicentre postmarketing study in 9657 patients.

In this postmarketing study 9657 patients (5181 children) with bronchitis (acute or chronic bronchial inflammatory disease) were treated with a syrup containing dried ivy leaf extract. After 7 days of therapy, 95% of the patients showed improvement or healing of their symptoms. The safety of the therapy was very good with an overall incidence of adverse events of 2.1% (mainly gastrointestinal disorders with 1.5%). In those patients who got concomitant medication as well, it could be shown that the additional application of antibiotics had no benefit respective to efficacy but did increase the relative risk for the occurrence of side effects by 26%. In conclusion, it is to say that the dried ivy leaf extract is effective and well tolerated in patients with bronchitis. In view of the large population considered, future analyses should approach specific issues concerning therapy by age group, concomitant therapy and baseline conditions.

Tiopental en la injuria cerebral aguda traumática / Thiopental in acute traumatic cerebral injury

El Tiopental Sódico en una dosis de 7-10mg/Kg de peso, en 5min, produjo un descenso constante de la presión intracraneana en 18 pacientes portadores de injuria cerebral aguda traumática, cualquiera fuera su nivel basal, entre 38% (dosis única) y 45% (dosis sucesivas). También provocó alteraciones hemodinámicas: a) locales, aumento de la presión de perfusión cerebral en el 85% de los pacientes y vasoconstriccicón (descenso constante del tono vasomotor, y b) sistémicos, descenso constante del gasto cardíaco, volumen sistólico, trabajos ventriculares derecho e izquierdo, variaciones no significativas de las resistencias arteriales sistémicas, presión venosa central y presión capilar pulmonar. Estas acciones son transitorias (30-51min) y las hemodinámicas corregibles con volumen y dopamina. El Tiopental es útil en el tratamiento de la hipertensión endocraneana con disminución crítica de la presión de perfusión cerebral y grandes tonos vasomotores que se producen en una onda A, aunque dosis acumuladas de la droga no siempre impidieron su aparición, no tenemos evidencia de que las hayan favorecido. El uso de la droga implica un monitoreo mínimo de la presión intracraneana y de la presión arterial media y cuando es necesario reinterar las dosis es muy probable que se requiera un catéter de Swan-Ganz. Si bien nuestra mortalidad no se modificó significativamente luego de utilizar la droga, se hacen imprescindibles estudios cooperativos para evaluar este aspecto clave de su utilidad