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Background Paroxysmal sympathetic hyperactivity (PSH) is an understudied complication of traumatic brain injury (TBI). PSH usually presents with transient rise in sympathetic outflow, leading to increased blood pressure, heart rate, temperature, respiratory rate, sweating, and posturing activity. We retrospectively analyzed the incidence of PSH in TBI using PSH-assessment measure (PSH-AM) scale. Methods This single-center retrospective cohort study was conducted in traumatic head injury patients admitted in the intensive care unit from January 1, 2016 to December 31, 2019 in a tertiary care center. The data was collected from the hospital database after obtaining approval from the hospital ethics committee. Results A total of 287 patients (18–65 years of age) were admitted to intensive care unit (ICU) with TBI out of which 227 patients were analyzed who had ICU stay for more than 14 days. PSH was diagnosed in 70 (30.8%) patients. Mean age of PSH positive patients was 40 ± 18 and 49 ± 11 years for PSH negative patients (p < 0.001). The age group between 40 and 50 years had a higher incidence of PSH. The age and Glasgow coma score (GCS) were significantly associated with the occurrence of PSH. The GCS score demonstrated good accuracy for predicting the occurrence of PSH with AUC 0.83, 95% CI of 0.775 to 0.886, and a p-value of 0.001. Conclusion We observed that the incidence of PSH was 30.8% in the patients with TBI. Age and GCS were found to have a significant association for predicting the occurrence of PSH. The patients who developed PSH had a longer length of hospital stay in ICU.

Background: The maintenance of hemodynamic stability is of pivotal importance in aneurysm surgeries. While administering anesthesia in these patients, the fluctuations in blood pressure may directly affect transmural pressure, thereby precipitating rupture of aneurysm and various other associated complications. We aimed to compare the effects of ketofol with propofol alone when used as an induction and maintenance anesthetic agent during surgical clipping of intracranial aneurysms. Materials and Methods: Forty adult, good-grade aneurysmal subarachnoid hemorrhage patients posted for aneurysm neck clipping were included in the study. The patients were randomized into two groups. One group received a combination of ketamine and propofol (1:5 ratio) and the other group received propofol for induction and maintenance of anesthesia. Intraoperative hemodynamic stability, intraventricular pressure, and quality of brain relaxation were studied in both the groups. Results: The patients were comparable with respect to demographic profile, Hunt and Hess grade, world federation of neurological surgeons (WFNS) grade, Fisher grade, duration of anesthesia, duration of surgery, optic nerve sheath diameter, and baseline hemoglobin. Intraoperative hemodynamics were better maintained in the ketofol group during induction, with only 15% of patients having >20% fall in mean arterial pressure (from baseline) intraoperatively, compared to 45% of patients receiving propofol alone (P = 0.038). The mean intraventricular pressure values in both the groups were in the normal range and the quality of brain relaxation was similar, with no significant difference (P > 0.05). Conclusion: Ketofol combination (1:5) as compared to propofol alone provides better hemodynamic stability on induction as well as maintenance anesthesia without causing an increase in intracranial pressure. Effect of ketofol on cerebral oxygenation and quality of emergence need to be evaluated further by larger multicentric, randomized control trials.

Background: Haemodynamic stability is the major goal of anaesthesia during intracranial aneurysm clipping . In the present study, we compared the effects of ketofol with propofol alone, used as an induction and maintenance agent during surgical clipping of intracranial aneurysm. Material and methods - Forty patients aged 18 to 75 years, posted for aneurysm neck clipping following aneurysmal Subarachnoid haemorrhage (SAH) were included in the study. The patients were randomized into two groups. One group received combination of ketamine and propofol (1:5 ratio) (Group KP) and the other propofol (Group P) for induction and maintenance of anaesthesia. Results - Combination of Ketamine and propofol ( in the ratio of 1:5) which was used in this study provided for better maintenance of Mean Arterial Pressure(MAP) during induction and maintenance of anaesthesia. Conclusion – Ketofol compared to propofol alone provides better hemodynamic stability on induction as well as during maintenance of anaesthesia in intracranial aneurysmal clipping surgery without increasing intracranial pressure.

Background: In most instances rapid emergence from general anesthesia after intracranial neurosurgery is desirable. The most compelling reason for this is the need for the patient to cooperate with a postoperative neurological examination intended to screen for such potential intracranial disaster as hematoma formation, herniation, and cerebrovascular accidents. Anesthetic techniques were adopted to achieve rapid emergence. In this respect, inhaled anesthetic agents have an important role in influencing the recovery time after anesthesia and surgery. The aim of this study is to compare isoflurane and sevoflurane as regard to speed of recovery from anesthesia and recovery of post-operative cognitive function in Indian populationMethods: The study was carried out as randomized control, blinded study of patients undergoing neurosurgery in tertiary care hospital. Sample sizes of 60 patients were studied. They were divided into two groups. Results: Sevoflurane shows faster emergence, extubation, motor control (in form of hand squeeze) and orientation time as compared to isoflurane. Though clinically the time difference for the various variables studied was 0.8 to 2.7 min only, statistically the results were significant and supported the basis for this difference as the difference in blood gas solubility coefficient between sevoflurane and isofluraneConclusions: Sevoflurane is recommended for use for faster extubation, emergence and post-operative neurological examination. The observation shows good brain relaxation with the use of both volatile anesthetic agents