No abstract

Improvements have been made with the recent adjustment of the reimbursement within the last year. Nevertheless, several factors identified in this study require additional adjustment: the ISS, the requirement of blood transfusion and the presence of additional chest trauma should be weighted in the calculation of reimbursement.

Congenital heart disease (CHD) is one of the leading congenital disease with the incidence of 8 patients of 1000 livebirth. Around 85% of patients with CHD is expected to reach adult age in United States of America. Management of traumatic brain injury in patients with CHD requires combination of fine understanding on pathophysiology of CHD and neuroanesthesia technique. A male patient, 17 years of age had a motor vehicle accident and was diagnosed with moderate traumatic brain injury, intracerebral hemorrhage, epidural hemorrhage and cerebral edema with Tetralogy of Fallot, underwent an emergency craniotomy for ICH evacuation. Surgery was done under general anesthesia and lasted for approximately 3 hours. Challenges during anesthesia and surgery include maintaining optimal oxygen delivery, avoiding increase in oxygen demand and preventing catecholamine release which may trigger hypercyanotic tet spell. Patient was observed and ventilator supported in Intensive Observation Ward and was extubated at the same post surgery day. Patient was then observed in the Ward and sent home on the 14th day after the incident.

Cerebellum cavernous also known as cavernous hemangioma is a vascular malformation of the cerebellum, usually with characteristics that appear on the magnetic resonance image (MRI). Cerebellum cavernous is the third most malformation of the cerebellum after venous anomalies and capillary telangiectasis with an incidence of 0.5% of the General population usually not noticed until a hemorrhagic event occurs. Cavernomas can be seen in conjunction with developmental venous anomaly (DVAs) in 20% (range 20%-40%) cases, in which case they are known as mixed vascular malformations. We describe anaesthetic management in a 28-year-old woman with cerebellum cavern with developmental venous anomaly (DVAs) that causes acute bleeding. Occipital craniectomy for cerebellar tumor resection is performed using neuronavigation under total intravenous anesthesia and scalp block using 0.5% ropivacaine without complications. The surgery lasts for six hours and the cavernomas can be removed completely. The patient was discharged home on the fifth day of postoperative surgery with no neurological deficit.

The ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients.