Emergence Delirium: Can Corticosteroids Contribute to It?

We report a case of emergence delirium after a propofol-based sedation for a renal biopsy in a teenager patient who had received high-dose and long-term corticosteroid treatment. Corticosteroid treatment is proposed as a possible risk factor for emergence delirium, although controlled studies are needed to assess this relationship. Although treatment for emergence delirium has not been well established, as described with steroid-induced psychiatric symptoms, antipsychotics could be a good therapeutic option.

Distal catheter lengthening in pediatric patients with hydrocephalus using a guidewire-assisted technique.

PURPOSE: The aim of this study was to evaluate the lengthening or replacement of the peritoneal catheter in a ventriculoperitoneal shunt by using a simple guidewire-assisted technique. Here we report on our experience with this methodology, its indications, caveats, and contraindications. METHODS: A prospective study was performed in 59 consecutively shunted children who required elective lengthening of the peritoneal catheter (25 females and 34 males, mean 10.5 + 4.2 years). The procedure required an incision of only 1 cm over the distal catheter. The catheter was sectioned, and a soft hydrophilic guidewire was inserted into the exposed end of it, which serves as a route for the guidewire to reach the intraperitoneal space. The procedure was followed by the replacement of the patient's catheter with one with additional length as considered appropriate, prior to putting additional slots in the last 5 to 8 cm of the new catheter. RESULTS: The technique was used in 62 CSF shunts (3 patients had a double derivative system). Fifty-five of the 62 (89%) procedures performed were effective. A conventional peritoneal opening technique was used in the 7 unsuccessful attempts. One patient presented a migration of the abdominal catheter during the first days after surgery. No incident of peritoneal perforation was associated with this technique, nor were any infections or other early or late complications associated with this surgical procedure. CONCLUSION: The technique we propose permits the peritoneal catheter of a derivative system to be lengthened or replaced in a manner that is simple, fast, and safe.

Characterization of the Ionic Profile of the Extracellular Space of the Injured and Ischemic Brain: A Microdialysis Study.

Traumatic brain injury (TBI) and ischemic stroke cause a variable disruption of ionic homeostasis and massive ionic fluxes with subsequent osmotic water movement across the cells that causes edema, brain swelling, and deformation of the damaged tissue. Although cerebral microdialysis (CMD) has been used to study the brain neurochemistry, the ionic profiles of brain interstitial space fluid have rarely been reported in humans. We studied the ionic profile in injured areas of the brain by using CMD. As a control group, we included seven patients who had undergone surgical treatment of posterior fossa lesions, without abnormalities in the supratentorial compartment. Inductively coupled plasma mass spectrometry (ICP-MS) was used for ion determination. No significant differences were found in the [Na+]o, [K+]o, and [Cl-]o between normal injured brains and controls. The ionic profile of the ischemic core was characterized by very high [K+]o and an increase in [Na+]o, whereas [Cl-]o was linearly related to [Na+]o. In the traumatic core (TC), significantly higher levels of [Na+]o, [Cl-]o, and [K+]o were found. The main finding in the penumbra was a completely normal ionic profile for [Na+]o and [K+]o in 60% of the samples. ICP-MS coupled to ionic assays creates a powerful tool for a better understanding of the complex ionic disturbances that occur after severe TBI and ischemic stroke.

Brain microdialysis as a tool to explore the ionic profile of the brain extracellular space in neurocritical patients: a methodological approach and feasibility study.

Our aim is to determine whether the ionic concentration in brain microdialysate enables calculations of the actual Na(+), K(+), and Cl(-) concentrations in vitro and whether this method can be applied to determine the ionic concentrations in the brain extracellular fluid. We designed an experiment using CMA-71 probes (M Dialysis, Stockholm, Sweden) and the standard conditions used in a clinical setting. Nine CMA-71 probes were inserted in different matrices and perfused with mock cerebrospinal fluid containing 3% albumin at the standard infusion rate used in the clinical setting (0.3 µL/min). Microvials were replaced every 12 h, and the ionic concentrations, both in the dialysate and the matrix, were analyzed. For each ion, scatter plots were built, with [Na(+)], [K(+)], and [Cl(-)] in the dialysate as the predictor variables and the matrix concentrations as the outcome variables. A linear regression model allowed us to calculate the true ionic concentrations in the matrix. To demonstrate the feasibility of the method, we present the calculated ionic profile of one patient with a malignant infarction and a second with a severe traumatic brain injury. Our results confirm that the ionic concentration in microdialysate can be used to calculate the true concentrations of ions in a matrix and the actual concentrations in the extracellular fluid. Microdialysis offers the unique possibility of monitoring the dynamic changes of ions in the brain over time and opens a new avenue to explore the brain's ionic profile, its changes in brain edema, and how this profile can be modified with different therapies.

Liberación de brida amniótica: implicaciones anestésicas / No disponible

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