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best-neurologist-in-gurgaon-blog · 6 years

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Brain Hemorrhage Treatment In Gurgaon

The facts:

A brain bleed or brain hemorrhage as it is called is bleeding in or around the brain. It can occur spontaneously as a large hemorrhage, with sudden onset catastrophic symptoms or it can occur gradually where it bleeds slowly over a period of time, with no apparent symptoms at all. It is said that almost 13% of strokes are caused because of hemorrhagic causes. It can be Traumatic or Spontaneous.

Why do they have different names?

These hemorrhages are given different names based on the exact location inside the skull where the bleeding occurs. Bleeding anywhere inside the cranial cavity is known as intracranial hemorrhage. Whereas bleeding into and within the brain tissue itself is called an intra-cerebral hemorrhage. But between the skull and the brain matter, you have what is the lining of the brain, made of three layers called the Dura mater, which is closest to the skull, Arachnoid mater, which lies in the middle and Pia mater, which is closest to the brain tissue. Bleeding can occur anywhere in between these layers as well.

Broadly they can be Traumatic or Non Traumatic.

These different types of hemorrhages are:

Extradural/epidural hemorrhage – which is bleeding between the skull and the Dura mater, which is commonly caused by trauma due to acceleration-deceleration forces and rupture of the meningeal vessels.

Subdural hemorrhage – which is bleeding between the Dura mater and Arachnoid mater. These hemorrhages are also again caused by trauma, but it is the subdural hemorrhages that most often tend to be chronic and innocuous as well.

Subarachnoid hemorrhage – is bleeding between the Arachnoid mater and the Pia mater. This type of bleeding is commonly caused by the rupture of an aneurysm.

NonTraumatic Basal Ganglia ICH (Most Common ICH encountered in Clinical practice), Thalamic ICH, Spontaneous Cerebellar Hematomas.

What are the signs to look out for to suspect an ICH?

The common symptoms which patients experience when they develop and ICH include:

Sudden onset severe headache

Any changes which follow trauma to the head should warn you about the development of an ICH

Neck stiffness

Nausea and vomiting

Altered levels of consciousness/loss of consciousness

Development of seizures

Neurological deficits such as numbness, weakness and impairment of vision and speech

In children you must suspect and ICH when the child presents with vomiting, seizures, loss of consciousness, swelling in the head or retinal hemorrhages. On most occasions the trauma which causes these types of injuries in children is due to child abuse.

How is an ICH diagnosed?

The most common investigation used to confirm the diagnosis of an ICH is the CT scan, because it is widely available. But where facilities are available an MRI scan is also equally useful for confirmation. A Magnetic Resonance Angiogram, if available will help to get an idea about the underlying cause of the ICH.

What are the treatment options available for intracranial hemorrhages?

There are different ways in which intracranial hemorrhages are managed depending on the exact location of the bleeding and the amount of bleeding which has occurred. The symptoms which the patient presents with also plays a role in determining the treatment plan. The various methods available for the management of an intracranial hemorrhage include non-surgical methods and surgical methods.

Surgical methods are required if the bleeding is extensive, which is determined by imaging techniques such as CT and MRI, or if the patient is displaying symptoms which are life threatening such as development of seizures and altered level of consciousness, all which occur due to increased intracranial pressure.

Non-surgical methods are used when the bleeding is minimal and the patient is asymptomatic. Your doctor will continue to monitor you, looking out for signs of increased intracranial pressure, and in the meantime you will be prescribed some medication such as anti-anxiety medication as well as drugs to prevent the development of seizures, and even pain relief medication, because some patient may only complain of a mild headache. Medication to reduce the swelling of the brain such as steroids as well as medication to bring down your blood pressure may be helpful in the management of an ICH.

What is the role of urgent surgery in intracranial hemorrhages?

Urgent surgery is most often required in the case of ruptured aneurysms which can cause subarachnoid hemorrhages or intra-cerebral hemorrhages. When it comes to intracerebral hemorrhages more often than not, your doctor will opt for immediate surgery because the brain matter can be extensively damaged if not intervened at the earliest, because of the increased intracranial pressure, leading to poor prognosis. Therefore the goal of urgent surgery is to save as much of the brain tissue as possible. The surgical options available are:

Decompression surgery using one of the four methods mentioned below:

Craniotomy – where the surgeon will make and incision in the scalp, remove a part of the skull, and drain the hematoma which has formed and repair the ruptured blood vessel. This is high risk surgery and is only performed when the bleeding is extensive, or when higher functions have been impaired in the patient.

Burr holeaspiration – where a small hole is drilled into your skull, through which a needle is inserted, and the hematoma is drained out. But for this you need to be able to identify the exact location of the hemorrhage, and it might turn out that the surgeon cannot completely drain the hematoma as well.

Endoscopic evacuation – which is similar to aspiration, but it involves the use of an endoscope which has camera and special equipment fitted at one end, and helps the surgeon visualize the insides of the cranial cavity.

During these procedures as well as due to the hemorrhage itself there is an increased risk the brain swelling up (cerebral edema). Therefore when the surgeon removes a part of the skull during a craniotomy, they may decide to replace it after some time, to allow for the contents of the cranial cavity to expand, while the swelling is still present. And once the edema is settled the part of the skull is replaced. This is known as a craniectomy. There are other methods which been used in order to tackle this problem of cerebral edema due to hemorrhage and surgery, which includes:

Duraplasty – which is a procedure used during the Chiari decompression surgery, where an incision is made in the Dura mater, and an extra patch is sewn in place in order to expand the surface of the Dura, to allow for the edema.

Cisternostomy – is a procedure where the basal cisterns are opened up to atmospheric pressure, in order to relieve the increased intracranial pressure which occurs as a result of cerebral edema. It is a novel technique which has replaced the older procedure of decompressive hemicraniectomy.

Brain hemorrhages can be a life threatening condition if not managed appropriately at the right time. But with the advent of newer and technologically advanced surgical methods, the success rate of surgical management is on the rise.

What precautions can I take to prevent the development of an ICH?

There is no specific method which can ensure that you prevent the development of an ICH. The main factor is to prevent trauma to the head as much as possible even when accidents do happen. Therefore taking the below mentioned precautions may help:

Wearing helmets when traveling on bikes, motorbikes, scooters and skateboards

Wearing your seatbelt when travelling in vehicles

Trying to prevent falls in an elderly

Non Traumatic ICH can be prevented by control of Blood pressure, regular check up from Neurologist/ Neurosurgeon and Diagnostic Angiograms.

What outcome can I expect following an ICH?

As an ICH is life threatening condition, the sooner it is treated the better the prognosis. But the overall outcome is dependent on the site where the bleeding occurs and how severe the bleeding was. Some patients may recover completely following management of the ICH, while some others may need rehabilitation such as speech therapy, physiotherapy and occupational therapy to help them perform their daily activities, if they have to overcome remaining neurological deficits.

#Brain Hemorrhage Treatment In Gurgaon #Brain Hemorrhage Treatment In Sonipat #Neurosurgeon Doctor In Gurgaon #Best Neurologist In Gurgaon #Best Neurosurgeon In Rohtak #Neurosurgeon In Faridabad #Neurologist In Rewari

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cagrreports21 · 3 years

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databridgemarketresearchblog · 5 years

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Global Intracranial Hematoma Drug Market Set to Surge Significantly During 2026

Market Analysis: Global Intracranial Hematoma Drug Market

Global intracranial hematoma drug market is expected to grow at a substantial CAGR of 6.4% in the forecast period of 2019-2026. The report contains data of the base year 2018 and historic year 2017. This rise in market value can be attributed to the rising cases of trauma, accidents, age related brain disorders, cancer among others, high prevalence of population suffering from hypertension and development in the healthcare expenditure and the government support for the research & development for new and better treatment have fueled the market growth.

Key Market Players:

The key market players in the global intracranial hematoma drug market are Pfizer Inc, Mylan N.V, Sun Pharmaceutical Industries Ltd, Johnson & Johnson Services, Inc, Medtronic, Spiegelberg GmbH & Co. KG, InfraScan, Inc, Integra LifeSciences Corporation, Arbor Pharmaceuticals, LLC, PDS Biotechnology, Orexo AB, Purdue Pharma L.P, Pharmaxis Ltd, Teva Pharmaceutical Industries Ltd., Novo Nordisk A/S, Idorsia Pharmaceuticals Ltd, AstraZeneca, Baxter, Penumbra, Inc, and others.

Market Definition: Global Intracranial Hematoma Drug Market

Intracranial hematoma is a condition which is characterized by the deposition of blood within the skull caused by bursting of blood vessel in the brain from any type of accident or trauma. The collection of the blood within the brain tissue or underneath the skull causes pressure on the brain tissues which damages the tissues leading to symptoms such as increasing headache, vomiting, drowsiness and progressive loss of consciousness, dizziness, confusion, unequal pupil size and slurred speech.

Get Sample Analysis of Global Market Information: https://www.databridgemarketresearch.com/request-a-sample/?dbmr=global-intracranial-hematoma-drug-market

Market Drivers:

Rising cases of trauma, accidents, age related brain disorders, cancer among others may act as a market driver

Change in lifestyles such as smoking and alcohol consumption has increased the risk for Intracranial hematoma which acts as a market driver

Increased research and development initiatives and expenditure, is also expected to drive the market growth

Market Restraints:

Stringent regulations and approval procedure by the authorities for the treatment, is expected to act as a restraint to the market growth

Lack of awareness amongst people about optimal diagnosis and treatment of intracranial hematoma restricts the growth of this market

Associated side effects of the drugs are expected to impede the market growth

Invasive nature of most intra-cranial pressure monitors which can hinder the market growth

Segmentation: Global Intracranial Hematoma Drug Market

By Types

Epidural Hematoma

Subdural Hematoma

Subarachnoid Hemorrhage

Intracerebral Hemorrhage

By Mechanism of Action

Osmotic Diuretics

Anticoagulants

Steroids

Antiepileptic

Others

By Drugs Type

Mannitol

Warfarin

Prednisone

Phenytoin

Others

By Diagnosis

CT Scan

MRI Scan

Angiogram

By Treatment

Medications

Surgical Drainage

Craniotomy

By Route of Administration

Oral

Intravenous

Others

By Distribution Channel

Direct

Online Pharmacy

Retailers

Others

By End-Users

Hospitals

Homecare

Specialty Clinics

By Geography

North America

Europe

Asia-Pacific

South America

Middle East & Africa

U.S.

Canada

Mexico

Germany

Italy

U.K.

France

Spain

Netherlands

Belgium

Switzerland

Turkey

Russia

Rest of Europe

Japan

China

India

South Korea

Australia

Singapore

Malaysia

Thailand

Indonesia

Philippines

Rest of Asia Pacific

Brazil

Rest of South America

South Africa

Rest of Middle East & Africa

Get TOC of Full Report: https://www.databridgemarketresearch.com/toc/?dbmr=global-intracranial-hematoma-drug-market

Key Developments in the Market:

In June 2019, Zebra Medical Vision, Inc received FDA 510(k) clearance for HealthPNX an AI alert for Intracranial Hemorrhage and pneumothorax (PNX). This AI software automatically detects patient’s internal brain bleeds based on standard, non-contrast head CTs. The usage of this software can assist in providing early detection in people suffering from high risk of severe brain bleeding events

In November 2018, MaxQ AI, Ltd received 510(k) clearance from FDA for Accipio Ix intracranial hemorrhage (ICH) detection software designed to detect non-contrast head CT images. The approval of this software will help in the early detection of the hematoma

Competitive Analysis:

Global intracranial hematoma drug market is highly fragmented and the major players have used various strategies such as new product launches, expansions, agreements, joint ventures, partnerships, acquisitions, and others to increase their footprints in this market. The report includes market shares of intracranial hematoma drug market for Global, Europe, North America, Asia-Pacific, South America and Middle East & Africa.

#Global Intracranial Hematoma Drug Market

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juniperpublishersanesthesia · 5 years

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Our Scalp Block Results in Craniotomy Cases-Juniper Publishers

Abstract

Aim: The aim of this study is to investigate the effect of scalp block performed with 0,5% of bupivacaine in craniotomy cases in preventing hemodynamic response due to the incision and its effect on postoperative analgesia and the need of analgesics.

Materials and method: The study was planned as a randomized, placebo controlled, double-blind study. 40 patients between the ages of 40-85 with ASA II-III classification were included in the study for elective craniotomy after the approval of the ethics committee and informed consents of the patients were received and they were separated into two groups (Group S: 20ml 0,9% normal saline, n=20), (Group B: 20ml0, 5% Bupivakain, n=20). Scalp block was performed 15 minutes before craniotomy. The mean arterial pressure (MAP) and heart rate (HR) of the patients wererecorded. Postoperative complications observed in the recovery room (bradycardia, hypotension, drug allergy, nausea, vomiting) were recorded. Pain was evaluated in postoperative conscious patients in the 2, 4, 8, 12, 16 and 24th hours with a 10cm visual analogue scale; and it was planned to administer 75mg of intramuscular meperidine if the VAS score was 5 and above in the postoperative period.

Result: During the craniotomy the MAP and HR values of the patients in Group S were significantly higher than Group B (p<0.05 respectively p=0.002, p=0.029). The VAS scores were also significantly higher in Group S compared to Group B in the postoperative 1, 2, 4, 6 and 12th hours (p<0.05 respectively p=0.022, p=0.031). Use of additional medication in Group S due to perioperative hypertension and tachycardia was significantly higher in comparison with Group B (p<0.001). Similarly, in terms of postoperative analgesic need, Group B had significantly less need for analgesics. Regarding the complications, however, no significant difference was found between the two groups.

Conclusion: In conclusion, scalp block ensures the stabilization of hemodynamic responses by reducing the sympathetic response in the intraoperative period in craniotomy cases and helps reduce the pain in the early postoperative period. We think that bupivacaine can be effectively used in scalp block procedures.

Keywords: Scalp block; Craniotomy; Bupivacaine

Introduction

The aim of neuroanesthesia is to prevent the increase of intracranial pressure without distorting the cerebral autoregulation and to ensure convenient surgical conditions and a safe anesthesia for the patient by maintaining a sufficient level of cerebral perfusion pressure (CPP). Anesthetic agents have obvious effects on cerebral metabolism, cerebral blood flow, cerebrospinal fluid (CSF) dynamics, intracranial volume and pressure [1]. As the intracranial pressure is directly related to the blood pressure, it is crucial to prevent the elevation of blood pressure due to any reason whatsoever in craniotomy patients. Radical elevations in systemic arterial pressure may temporarily distort cerebral autoregulation and, if not prevented, may cause cerebral edema by increasing the pressure in cerebral capillaries. Particularly, in interventions related to lesions involving intracranial areas, the detrimental effects of acute hypertension are more obvious as intracranial compliance is already decreased. Especially if the autoregulation capacity of cerebral vessels is already compromised, this increase will lead to an increased intracranial pressure [2]. Since increased intracranial pressure may cause a decrease in cerebral perfusion pressure or a shift effect in the brain, it should absolutely be prevented before durotomy [3].

Painful stimulants and sudden increases in blood pressure and heart rate cause herniation, cerebral aneurism and arteriovenous malformation rupture by increasing the intracranial pressure, and lead to ischemia in subarachnoid hemorrhage patients, who develop vasospasms, and an increase in the potential morbidity risk. Furthermore, hemodynamic instability will lead to adverse effects in those with atherosclerotic heart disease in the preoperative period [4,5]. Cranial surgical procedures involve continuous change in the intensity of painful stimulants, therefore they require a very close monitoring of the level of anesthesia [3,6].

The aim of scalp block is to block the nerves innervating the scalp at their exit points from the scalp before they form branches with the use of local anesthetic agents. Minor and major occipital nerves innervating the scalp, supraorbital and supratrochlear nerves, zygomaticotemporal nerve, auriculotemporal and major auricular nerve are blocked. As a result, the transmission in the fibers located in the nerve trunk in the area where the drug is delivered is blocked. Scalp block was first defined by Pinosky and bupivacaine was used as the local anesthetic agent. The most frequently used agent has also been bupivacaine in further studies, however there are also some studies performed with lidocaine, ropivacaine and levobupivacaine [5,7,8].

Mainly bupivacaine, ropivacaine and lidocaine have been used for scalp block in the studies [8-10]. Scalp block is a difficult technique requiring the use of local anesthetics in high volumes, which in turn increases the risk of local anesthetic toxicity in patients [9,11]. In awake craniotomies, an average of 150-175mg of levobupivacaine is used for the scalp block and maximum concentration measured in the plasma is 0.98-2.51µg/ml and the time needed to reach this level of concentration is 5-15 minutes and no central nervous system or cardiovascular system toxicity is observed at this level of concentration. It is reported that post-craniotomy pain is less than the pain experienced after operations such as lumbar laminectomy or fascial reconstruction ]12[. However, in contradiction to the general opinion, moderate or severe pain after craniotomy is reported to be quite common and it is observed that this pain is very intense particularly in the first 2 hours after craniotomy [13]. For the treatment of this pain, either local anesthetics are injected to the scar area or systemic nonsteroidal anti-inflammatory agents, drugs such as ketamine, opioids, or tramadol are given. In the meantime, there is still an ongoing search for an ideal analgesic agent and or approach in craniotomy cases complaining of severe pain. If the patient is conscious and have a perception of pain, postoperative analgesia should absolutely be used [14-16]. Bupivacaine is an amide type local anesthetic and was developed by Ekenstom et al. in 1963, it is available as hydrochloride salt in the market. It provides analgesia without motor block in low densities. Since it is highly fat-soluble, its systemic absorption is slow. It is metabolized in the liver except for a small portion excreted through the kidneys. It becomes effective within 5-10 minutes. This duration may reach up to 20 minutes in caudal and peridural injections. Motor and sensorial blockade may last up to 3 hours. It reaches maximum plasma concentration after 30-45 minutes. Its half-life is 9 hours in adults. It is one of the longest acting local anesthetics (5-16 hours). Scalp block is a method used to relieve pain in the early postoperative period and to help ensure hemodynamic stabilization in the intraoperative period [17]. In this study we aimed to investigate the effect of scalp block performed with bupivacaine in elective craniotomy cases in preventing hemodynamic response due to incision, and its effect on postoperative analgesia and the need for analgesics.

Materials and Method

The ethics committee approval was received from the Clinical Studies Ethics Committee of Samsun Ondokuz Mayis University, Faculty of Medicine (Approval number B.30.2.ODM.0.20.08/1192). The study was planned between June/1/2015-December/31/2015. The study was started after receiving the consents of the patients planned to be included in the study. 40 patients, who were accepted at the Neurosurgery clinics of Ordu University Training and Research Hospital and Ordu State Hospital for elective craniotomy due to intracranial mass, were included in the study. Our study was a multicenter, randomized, placebo controlled, double-blind study. 40 patients to undergo elective craniotomy in the study were between the ages. of 40-85, in ASA II-III groups according to the risk classification of the American Society of Anesthesiologists (ASA) defining the physical condition of the patients. All the patients were informed about the study beforehand, and written consents were received from the volunteers who accepted to participate in the study. Those who had a systemic disease under ASA IV risk class, who had allergy against bupivacaine, advanced stage organ failure, alcohol and substance addiction and who were below the age of 40 and over the age of 85 were excluded from the study In our study, patients were not excluded from the study and all data were analyzed. Attached consort diagram drawn for our scientific work (Figure 1).

The patients were randomized with the sealed envelope method before the induction into 2 groups each comprising 20 patients; 20ml of 0.5% bupivacaine (Group B) and 20ml of 0.9% normal saline as the control group (Group S). Preoperative routine monitoring of the patients was done with Datex-Ohmeda Cardiocap™/5 (GE, Finland) device, followed by electrocardiogram (ECG), peripheral oxygen saturation (SpO2) and noninvasive blood pressure monitoring. Before the induction of anesthesia all the patients were premedicated with 0.05mg/kg of intravenous midazolam. After the induction of anesthesia with 2-3mg/kg of intravenous propofol, 2µg/kg of intravenous fentanyl and 0.6mg/kg of intravenous rocuronium, invasive arterial monitoring was performed by inserting a 20G intra-arterial cannula into the radial artery. Anesthesia was maintained with 6mg/kg/h of propofol infusion, 0.15mg/kg of intravenous rocuronium and 0.25µg/kg/min of continuous intravenous infusion of remifentanil. The patients were exposed to mechanical ventilation to reach an EtCO2 level of 30-35 mmHg with an air mixture of 50% O2. Once the baseline hemodynamic values were recorded before and after the induction, scalp block was performed. Skull-pin head holder was placed 5 minutes after the block was done. The medication to be used for the scalp block was prepared in a 20ml syringe by an anesthesiologist, who would not attend the surgery. 20ml of normal saline was put in the syringe for Group S. After being numbered according to the results of randomization, the responsible anesthesiologist made the injections with a 23G needle on the outer layer of the skull by inserting the needle into the skin with a 45° angle. Supraorbital and supratrochlear nerves were blocked by the injection of a 2ml solution on the bilateral supraorbital notch above the eyebrows. Bilateral auriculotemporal nerves were blocked by injecting a 2ml solution at 1.5cm anterior to the ear at tragus level. Bilateral postauricular nerves were blocked by injecting a 3ml solution at 1.5cm posterior to the ear at tragus level. Finally; the major, the minor and the third occipital nerves were blocked by injecting a 3ml solution at the intersection point of the midsection of the line between protuberentia occipitalis and mastoid process, and the upper nuchal line. Skull-pin head holder was placed by the neurosurgeon 5 minutes after the block.

Regarding the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2) and end- tidal carbon dioxide (ETCO2) of the patients; the time when the patient was taken into the operating room before the scalp block was accepted as 0 min (= control value). After the scalp block was done, in the 1st, 5th and 10th minutes and then in the 20th, 30th, 40th, 50th, 60th, and 70th minutes, all the parameters were recorded until the end of the operation with 10-minute intervals.

Postoperative pain was evaluated in patients, who were conscious after the operation, in the 2nd, 4th, 8‘h, 12th, 16th and 24th hours with a 10cm visual analogue scale (0 is no pain, 10 is the worst possible pain). It was planned to give 75mg of intravenous diclofenac sodium to patients with a VAS score above 2 and 75mg of intramuscular meperidine to patients with a VAS score above 5. Postoperative analgesic needs and the amount of analgesics used were recorded.

Decrease of SpO2 below 94% for 45 seconds was accepted as hypoxia and elevation of ETCO above 45mmHg was assessed as hypercapnia. Hypertension was accepted as an increase of SBP by 20% above the control value and tachycardia was defined as a heart rate of at least 20% above the control value, and it was planned to administer 2µg/kg of intravenous fentanyl and to increase the propofol infusion dose to 9mg/kg/h. It was planned to administer 0.01mg/kg of bolus intravenous nitroglycerin if SBP and HR were still 20% above the control values.

Hypotension was accepted as an SBP value of 20% of the control value and less and 5-10mg of intravenous ephedrine was planned to be administered. Bradycardia was assessed as 20% below the control value or a value less than 40beats/ minute, and 0.5mg of intravenous atropine was planned. 10mg of intravenous metpamid was planned for the treatment of postoperative nausea and vomiting, and in the case of blurred vision or tinnitus the plan was to keep the patient in the recovery room for a longer period of time and observe.

SPSS for Windows 21.0 package program was used for the statistical analysis of this study. For measurable parameters (age, weight, amount of remifentanil, duration of anesthesia, duration of operation) the Kolmogorov-Smirnov test was used in order to identify whether the distribution was normal or abnormal. For those with normal distribution, Student t test was employed in independent groups to see whether there were differences between the groups. Data, such as gender and ASA, were analyzed with the Chi-square test. Heart rate and MAP data were assessed with repeated measures analysis of variance. In cases of differences, the comparison between the groups was done with the intergroup Posthoc-Scheffe test. Intragroup control values of HR and MAP, for which it was determined that the time factor was crucial according to the repeated measures analysis of variance, were compared by using the Post hoc Bonferroni test. Mann-Whitney U test was employed for the comparison of postoperative VAS scores between the two groups. For statistical analyses p<0.05 was accepted as significant.

Results

None of the 40 patients in the study was excluded from the study. The age, body weight, height, gender, ASA classification of the patients, duration of anesthesia and operation, the total amount of remifentanil used during the operation were found to be similar. All the patients were referred to the surgical intensive care units of Ordu University Training and Research Hospital and Ordu State Hospital postoperatively (Table 1). Demographic characteristics of the groups did not indicate any statistically significant difference.

The average values of the heart rate (HR) according to the time of measurement are given in Table 2. While there was no difference between the groups in the control measurements in terms of average heart rates, the HR value after intubation was found to be significantly lower in Group B as compared to Group S (p<0,05). When the intragroup HR values measured at different times were compared according to the control value, it was observed that the average HR values were not statistically different from the control HR average values in both groups. The average values of the mean arterial pressure (MAP) according to the measurement times are given in Table 3. While there was no significant difference between the groups in terms of mean arterial pressure values in the control measurements, the MAP values acquired in the intraoperative 20th and 30th minutes after the scalp block were found to be significantly lower in Group B compared to the control group (normal saline group) (p<0,05). When the intragroup differences were investigated, on the other hand, intraoperative MAP values measured in the 10th, 20th, 30th, 40th, 50th, 60th, and 70th minutes after the scalp block in Group B were observed as significantly lower than the control values (p<0.05).

*p<0.05: in comparison with Group S.

*p<0.05: in comparison with Group S, µ: p<0,05: in comparison with the control measurement values.

**p<0.01: in comparison with Group S

Postoperative pain assessment results of the conscious patients according to the visual analogue scale are given in Table 4 and Figure 2. The VAS scores acquired in the postoperative 30th min, 60th min, 2nd, 4th, 6th and 12th hours were found quite significantly lower in Group B as compared to Group S. The values in the recovery room and postoperative 24th hour were close to the statistical significance level in Group B (p=0.05 and p=0.06 respectively). No serious complications such as nausea, vomiting, bradycardia, and hypotension was observed in any of the patients in the postoperative period. In Group B, except for the patient, who needed 75mg of diclofenac sodium, no patients required meperidine. In Group S, on the other hand, 12 patients (60%) required meperidine in addition to diclofenac sodium particularly in the postoperative 12th and 24th hours.

Discussion

There is a common belief that those undergo neurosurgery suffer from minimum postoperative pain and need analgesics. While it is obvious that this group of patients experience relatively less pain when compared to those underwent orthopedic surgery or thoracic surgery, more than 60% of these patients feel moderate to severe postoperative pain. In a study conducted by Benedittis et al.90% of the patients suffered from post-craniotomy pain in the first 12 hours, which sometimes extended to 48 hours [18]. Our results overlap with those reported in the study of Benedittis et al. Likewise, in our study, there were many patients with a VAS score of 5 and above in the control group (normal saline group, Group S) particularly in the 12th and 24th hours. In a retrospective study conducted by Quient et al. postoperative pain in elective craniotomy patients was assessed in the first 24 hours. In the first 2 postoperative hours, 18% of the patients complained about severely distressing pain; 37% of the patients had severe, 29% had medium and 4% had mild pain. Only 12% of the patients did not describe a post-craniotomy pain in the first 24 hours [19]. Persistent post-craniotomy headache has also been identified and its incidence increases with postoperative unsuccessful analgesia [20,21]. In a study by Kaur et al. [21] 22 out of 126 supratentorial surgery patients developed persistent headache. 7 of these cases (5.6%) had headache for a period of longer than 2 months but shorter than 1 year; 15 cases (11.9%) had headaches for more than a year in the postoperative period.

In neurosurgery cases, laryngoscopy, skull-pin applications, interventions to the periosteum and dura cause painful stimulants. Even in cases with sufficient anesthetic depth, skullpin application and skin incision lead to acute hypertensive response [2,22]. Following the skull-pin placement, efferent pain sensation generated from the periosteum results in severe acute hypertensive response due to sympathetic system activation and eventually, intracranial pressure increases . This technique, which was defined for the first time by Pinosky et al. [10] and had not been implemented in practice before, was compared in a prospective, randomized, double-blind study in terms of the effect of scalp block performed by using 0.5% bupivacaine and normal saline on hemodynamic response to skull-pin placement and on the anesthesia need; and they were able to show that scalp block was successful in controlling the hemodynamic response to skull-pin placement. In our study, we followed the exact description of Pinosky et al. [10] while performing the scalp block. Lee et al. investigated the effect of scalp block performed with 0.25% bupivacaine under general anesthesia on hemodynamics and plasma catecholamine metabolites. 16 elective craniotomy patients were included in this prospective, randomized, double-blind study. One group underwent scalp block procedure with normal saline under general anesthesia induced with isoflurane and 50% N20-02, while the other group underwent the same procedure with a total of 20ml of 0.25% bupivacaine. Looking at the heart rate and mean arterial pressure measurements, it was revealed that scalp block led to more stable hemodynamics and decreased the need of intravenous or volatile anesthetics [23]. We used 0.5% bupivacaine and obtained more stable perioperative hemodynamics just as Lee et al. did in their study.

Gazoni et al. [8] compared perioperative results of the scalp block performed with ropivacaine in patients, who had supratentorial brain tumor, with remifentanil. In the prospective, randomized, double-blind study, while one group received 0.5% ropivacaine during the scalp block procedure, theother group received remifentanil infusion. Although, it was reported that scalp block did not bring along significant advantages in terms of postoperative pain and narcotic analgesics need when compared to remifentanil infusion, it was observed that hemodynamic parameters (MAP, HR) were more stable with the scalp block procedure.

Geze et al. compared the effects of scalp block and local infiltration on hemodynamics and stress response in craniotomy cases with skull-pin placement. In this prospective, randomized, placebo-controlled study, one group had scalp block with 0.5% bupivacaine and another group had local anesthetic infiltration with 0.5% bupivacaine; in the control group, on the hand, in order to prevent excessive hemodynamic responses, after an IV bolus of 0.5µg/kg remifentanil or a loading dose of 500µg/kg/ min esmolol, an IV infusion of esmolol 50µg/kg/min for 4 min was administered. In the study, it is reported that in the scalp block group, increase in blood pressure and heart rate due to skull-pin placement was prevented; there was no need for an additional anesthetic and antihypertensive agent, and blood pressure and heart rate were more stable when compared to the local infiltration and the controlgroups. When the groups are compared in terms of their metabolic and endocrine responses to surgery, stress response was significantly lowered after skull-pin placement in the scalp block group in comparison with the control group. In our study, we also used 0.5% bupivacaine and obtained well-matched results with that of Geze et al. We also observed perioperative hypertension and tachycardia in patients included in the normal saline group. 86% of the patients have pain with somatic features indicating that the source of pain is pericranial muscles and soft tissue. It is also known that local anesthetics administered before the skin incision on scalp have preemptive analgesic effect [24]. Therefore, scalp block is a technique that can be preferred to be used as a stand-alone analgesic method or to decreasethe dose of analgesics [25]. Taking all these remarks into account, we interviewed our conscious patients in the postoperative 30thmin, 1st, 2nd, 4th, 6th, and 24th hours on VAS and the use of additional analgesics. Our VAS scores were significantly lower in the bupivacaine group compared to the normal saline group.

Ayoub et al. [26] investigated the efficacy of scalp block in a group of 50 patients following remifentanil-based anesthesia. In this double-blind study, anesthesia was induced with 1-3mg/ kg of propofol and 1.0µg/kg of IV bolus remifentanil; followed by 0.1µg/kg/min of intravenous remifentanil infusion. The patients were randomized into two groups; one group having scalp block with bupivacaine or lidocaine and the other group having 0.1mg/kg intravenous morphine during dural closure at the end of the surgery. As an additional analgesic agent, codeine was administered subcutaneously in both groups. Both groups had similar pain scores. There was no significant difference between the two groups in terms of the total dose of codeine administered and the first codeine dose. While there was no difference between the groups in terms of confusion, nausea and vomiting was higher in the morphine group. The authors indicated that scalp block offered the same analgesic quality with a postoperative hemodynamic profile similar to morphine. Scalp block is an adjuvant method that can be used in order to avoid nausea and vomiting experienced with opioids [26]. Similarly, Bala et al. performed scalp block in 40 supratentorial craniotomy patients with bupivacaine or placebo following skin closure and they used intramuscular diclofenac or intravenous tramadol as analgesic. Patients without a scalp block had moderate to severe pain and had more frequent needs of additional analgesics. In this study too, it was revealed that the pain scores recorded after 6 hours were equal [27]. In our study, on the other hand, we obtained pain-free postoperative periods of over 12 hours, even extending to 24 hours. Scalp is a highly vascularized area, there are some studies analyzing the rate of transmission of local anesthetics applied to this area to the systemic circulation [7,28]. In our study, bupivacaine was administered very slowly in order to avoid drug toxicity, as it was required in high volumes in scalp block procedures and prior to the administration of bupivacaine, needle aspiration was performed in order to avoid accidental intra-arterial injection. After making sure that there was no blood, local anesthetic agent was injected. Although the patients were not monitored for QT intervals, there was no arrhythmia or asystole observed in routine ECG monitoring. In the postoperative period, no findings such as blurry vision, tinnitus or convulsion indicating systemic toxicity were reported.

Conclusion

In conclusion, in craniotomy cases, scalp block provides stabilization of hemodynamic responses by decreasing sympathetic response intraoperatively and helps reduce the early postoperative pain. Therefore, we believe that scalp block should play a more important role in anesthesiology practices and should be performed in all craniotomy patients.

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For more articles in Journal of Anesthesia & Intensive Care Medicine please click on: https://juniperpublishers.com/jaicm/index.php

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#Scalp block #Craniotomy #Bupivacaine #Juniper Publishers #Open access Journals

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infraindia · 6 years

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Intra-cranial Pressure (ICP) Monitor Market Dynamics, Major Companies Analysis and Forecast 2022

Market Research Future Published a Half-Cooked Research Report on Intra-cranial Pressure (ICP) Monitor Market Research Report.

Global Intra-cranial Pressure (ICP) Monitor market, although in its embryonic stage, is still witnessing an outstanding growth over the past couple of years. This growth attributes to the ability of these monitors in the field of neurosurgery in processes such as the external ventricular draining, CSF circulation, and CSF functions among others.

Furthermore, traumatic brain injuries and diseases that are impacting the brain health such as intra-cerebral hemorrhage, meningitis, and neurological damages among others are fostering the market growth to an extent. The neurology sector has been witnessing the emergence of many advent devices over the past few years which is increasing the market size with the huge demand for ICP monitors, increasing applications of these monitors. Resultantly, the ICP monitor market is escalating on the global platform.

Acknowledging the traction, this market is vibrating with currently; Market Research Future (MRFR) in its recently published study report giving asserts that the global intra-cranial pressure monitor market gaining further prominence will register a spectacular growth by 2022, growing at an impressive CAGR during the review period (2016 – 2022).

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Additional factors substantiating the market growth include increasing government funding and programs primarily in the developing regions to support the R&D activities undertaken to bring more advancements and inventions in these monitors. Technological advancements in the field of telehealth, telemetric monitoring, and in smart and connected devices along with penetration of ubiquitous technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI) are fostering the market growth of ICP monitors.

Furthermore, factors such as the increasing prevalence of neurological diseases and disorders of the nervous system such as Schizophrenia, Parkinson’s disease, and Cerebral Palsy alongside the changing lifestyle led by the growing urbanization and industrialization are fostering the market growth. Undoubtedly, improving economic conditions are supporting the market growth enabling access to quality care and improved healthcare worldwide

To respond to the growing demand for futuristic monitors, manufacturers are developing devices with advanced technologies. To identify the unmet clinical needs, some caregiving facilities are aiming to have high-quality screening (monitoring) available in their facilities.

On the flip side, factors such as high costs of ICP monitors along with the low or no awareness among consumers towards the availability and advantages of these monitors are obstructing the market growth. Nevertheless, new product development alongside services made available in the developing and developed countries by the matured market players are some of the factors expected to support the market growth during the anticipated period, filling up the demand and supply gap.

Global Intra-cranial Pressure Monitor Market – Competitive Analysis

Global intra-cranial pressure monitor market appears to be competitive & fragmented owing to the several small & big players accounting for a substantial market share. Through strategic initiatives such as partnership, acquisition, collaboration, expansion, product & technology launch, these players try to gain the competitive advantage in the market.

Key Players:

Some of the eminent leaders of the market include Compumedics Limited (Australia), Covidien Plc. (Ireland), Natus Medical Incorporated (US), Codman & Shurtleff, Inc. (US), Integra LifeSciences Corporation (US), Raumedic (USA), and Vittamed.

Industry/Innovation/Related News:

October 04, 2018 – IRRAS AB (Sweden), a medical technology company involved in development and commercialization of innovative brain surgery solutions announced that it has completed its initial review of the IRRAS recertification application for its Notified Body, LNE/G-MED, associated with the CE Mark of the IRRAflow catheter.

May 31, 2018 – Branchpoint Technologies (US), a company dedicated to providing accurate, reliable and cost-effective mobile solutions for ICP monitoring announced receiving of FDA approval its AURA™ ICP Monitoring System, including a completely implantable and wireless ICP sensor that enables truly mobile ICP monitoring in brain-injured patients. The AURA™ ICP Monitoring System also enables reliable telemetric monitoring of parenchymal ICP such as continuous ICP waveforms, weaving off the need to have additional capital equipment investments.

Global Intra-cranial Pressure Monitor Market – Segmentations

MRFR has segmented its analysis into four key dynamics for enhanced understanding.

By Techniques : Invasive and Non-Invasive among others.

By Methods : Intra-Ventricular Catheter, Subdural Screw, and Epidural Sensor among others.

By Applications : Traumatic Brain Injury, Intra-Cerebral Hemorrhage, and Meningitis among others.

By Regions : Europe, North America, APAC and Rest-of-the-World.

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Global Intra-cranial Pressure Monitor Market – Geographical Analysis

Globally, North America is dominating the global Intra-cranial pressure monitor market. Furthermore, factors such as extensive demand and uptake of technologically advanced monitoring devices in medical, increasing public & private organizations’ support for R&D activities and high healthcare expenditures substantiate the market growth include. With the growing prevalence of neurological disorders, the North American ICP monitor market is expected to evaluate phenomenally by 2022.

The European region is another lucrative market for ICP monitors. Increasing focus on the development of advent monitors alongside rising government support for R&D activities is contributing to the market growth. Also, the increasing numbers of specialty services offered by various healthcare providers foster the growth of the market in Europe.

The Asia Pacific region is rapidly emerging as a promising market for ICP monitor, growing rapidly. Increasing incidents of neurological disorders are fuelling the market growth. Moreover, factors such as the augmenting demand for quality equipment and proliferating healthcare technology are projected to provide impetus to the market growth, leading to the increasing the uptake of ICP monitors.

#Intra-cranial Pressure (ICP) Monitor Market #Healthcare #medical

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ashukalbande21-blog · 6 years

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Intra-cranial Pressure (ICP) Monitor Market Trends and Opportunities from 2019 to 2022

Market Research Future Published a Half-Cooked Research Report on Intra-cranial Pressure (ICP) Monitor Market Research Report.

Get Sample Copy @ https://www.marketresearchfuture.com/sample_request/2042

Global Intra-cranial Pressure Monitor Market – Competitive Analysis

Key Players:

Industry/Innovation/Related News:

Global Intra-cranial Pressure Monitor Market – Segmentations

MRFR has segmented its analysis into four key dynamics for enhanced understanding.

By Techniques : Invasive and Non-Invasive among others.

By Methods : Intra-Ventricular Catheter, Subdural Screw, and Epidural Sensor among others.

By Applications : Traumatic Brain Injury, Intra-Cerebral Hemorrhage, and Meningitis among others.

By Regions : Europe, North America, APAC and Rest-of-the-World.

Access Report @ https://www.marketresearchfuture.com/reports/intra-cranial-pressure-monitor-market-2042

Global Intra-cranial Pressure Monitor Market – Geographical Analysis

#ntra-cranial Pressure (ICP) Monitor Market

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wenitinblog-blog · 7 years

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Intracranial Hemorrhage Diagnosis and Treatment Industry: Global Survey, Trends, Outlook, Overview and 2023 Forecast

Key players of Global intracranial hemorrhage diagnosis and treatment Market:

· Medtronic Plc.

· Codman & Shurtleff Inc.

· Raumedic AG

· Vittamed

· Sophysa Ltd.

· Orsan Medical Technologies

· Spiegelberg GmbH

· Johnson & Johnson

· Sophysa Ltd

· HaiWeiKang

· Head Sense Medical

· InfraScan Inc.

· Integra Life Sciences Corporation

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Market Scenario:

Bleeding or haemorrhages loss of blood from the circulatory system which may be internal or external due to variety of conditions such as trauma, tissue damage due to surgery, accidents, cuts etc. Generally loss of 10–15% of the total blood volume does not cause serious mental problems and can be tolerated by the body. Intracranial haemorrhaging is bleeding in the brain due to trauma or medical conditions such as cancer, tumour etc.

The market for global intracranial haemorrhage treatment is chiefly driven by factors such as rising cases of trauma, accidents, age related brain disorders, cancer etc. The critical market constraints is the invasive nature of most intra-cranial pressure monitors.

Considering all these factors the market for intracranial hemorrhage diagnosis and treatment is expected to reach $ 1.9 billion by the end of 2023, this market is projected to growing at a CAGR of ~ 6.1 % during 2017-2023.

Regional analysis

US accounts for the maximum market share due to favorable reimbursement scenario and greater expenditure on healthcare. Europe is the second largest market due to large disposable income and rising awareness. Asia pacific region will be the fastest region because of large unmet needs which will be led by China and India. The Middle East and Africa market will be led by the gulf nations particularly Saudi Arabia and UAE. The poor regions of Africa is expected to be a laggard due to poor economic and political conditions.

Market Segments:

· The global intracranial hemorrhage diagnosis and treatment market is segmented on the basis of devices and types.

· Based on the devices, the market has been segmented as invasive and non-invasive. The invasive segment is sub-segmented into ventricular drainage pressure monitors, lumbar drainage pressure monitors, micro-transducer pressure monitors. The non-invasive segment is sub-segmented into tissue resonance analysis (TRA) and Trans Cranial Doppler (TCD). Based on the types, the market has been segmented as intracranial hemorrhage treatment, cerebral hemorrhage, subarachnoid hemorrhage, postpartum hemorrhage, pulmonary hemorrhage, and other.

· Based on the drugs, the market has been segmented as anti-hypertensive, coagulants, and others.

· Based on the surgeries, the market has been segmented as decompression surgery, craniotomy with open surgery, simple aspiration, endoscopic evacuation, stereotactic aspiration, and clipping or coiling procedures.

Study objectives:

To provide detailed analysis of the market structure along with estimated future growth forecast for the next 6 years about various segments and sub-segments of the global intracranial hemorrhage diagnosis and treatment market.

To provide insights about factors affecting the market growth.

To analyze the global intracranial hemorrhage diagnosis and treatment market based on various factors - Price Analysis, Supply Chain Analysis, Porters Five Force Analysis etc.

To provide past and estimate future revenue of the market’s segments and sub-segments with respect to four main geographies and their countries - Americas, Europe, Asia-Pacific along with Middle East & Africa.

To provide country level analysis of the market with respect to the current market size and future growth prospect.

To provide country level analysis of the market’s segments which includes by devices, types, drugs and surgery and sub-segments.

To provide overview of key players and their strategic profiling in the market, comprehensively analyzing their core competencies and drawing a competitive landscape of the market.

To track and analyze developments which are competitive in nature such as joint ventures, strategic alliances, mergers and acquisitions, new product developments along with research and developments currently taking place in the global intracranial hemorrhage diagnosis and treatment

Check Discount for this Report @ https://www.marketresearchfuture.com/check-discount/3687 .

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MRFR team have supreme objective to provide the optimum quality market research and intelligence services to our clients. Our market research studies by products, services, technologies, applications, end users, and market players for, regional, and country level market segments, enable our clients to see more, know more, and do more, which help to answer all their most important questions.

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#Intracranial Hemorrhage Diagnosis and Treatment Market Research

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