Cerebral Hemodynamic Effects of Morphine and Fentanyl in Patients with Severe Head Injury: Absence of Correlation to Cerebral Autoregulation

Nadal, Miriam de; Munar, F.; Poca, A; Sahuquillo, Joan Carles; Garmacho, Angel; Rosselló, J.

doi:10.1097/00132586-200010000-00025

Cited by 21 publications

(29 citation statements)

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“…[32] In addition, morphine has other unfavorable side effects such as respiratory depression, increase in intracranial pressure, hypotension, [33] and decrease in cerebral perfusion pressure. [34] Nevertheless, none of these effects were observed in our study. It seems that the concern is more prominent in critically ill and/or severely injured patients and in higher doses of morphine.…”

Section: Subdural Hematomacontrasting

confidence: 70%

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

Ahmadi¹,

Hashemian²,

Pishbin³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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Section: Subdural Hematomacontrasting

confidence: 70%

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

Ahmadi¹,

Hashemian²,

Pishbin³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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“…There was no correlation between PaCO 2 and the initial VMCA. Fourteen patients (66%) had impaired cerebral autoregulation, including seven of the 14 patients (50%) with a PaCO 2 < 40 mmHg [28][29][30][31][32][33][34][35][36][37] and all seven of the patients with a PaCO 2 > 40 mmHg [41][42][43][44][45][46][47][48][49] (P = 0.046). Specifically, 4/9 (44%) patients with PaCO 2 < 35 mmHg, 7/9 (77%) with PaCO 2 between 35 and 42 mmHg, and 3/3 (100%) with PaCO 2 > 42 mmHg had impaired autoregulation.…”

Section: Resultsmentioning

confidence: 99%

“…Steady state conditions were maintained during the study, and we avoided hyperglycemia, extreme acidosis, and uremia, and changes in temperature and hemoglobin concentration, all factors that are known to affect cerebral autoregulation [18]. The drugs used for sedation or analgesia and norepinephrine do not influence cerebral autoregulation [32][33][34], so that one can assume that modifications in VMCA were due only to changes in MAP.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Autoregulation is Influenced by Carbon Dioxide Levels in Patients with Septic Shock

et al. 2009

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“…Almost a third of the subjects in our cohort received a narcotic in the ED. Narcotics have been shown by several authors to adversely affect hemodynamic parameters after severe TBI in humans, and to increase mortality after TBI in rats (de Nadal et al, 2000;Statler et al, 2006). In addition, a third of our cohort received a nonsteroidal anti-inflammatory drug-primarily oral ibuprofen and intramuscular ketorolac-in the ED.…”

mentioning

confidence: 99%

Sex Differences in Outcome after Mild Traumatic Brain Injury

Blyth¹,

Mookerjee²,

He³

et al. 2010

Journal of Neurotrauma

299

196

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The objective of this study was to estimate the independent association of sex with outcome after mild traumatic brain injury (mTBI). We performed an analysis of a subset of an established cohort involving 1425 mTBI patients presenting to an academic emergency department (ED). The associations between sex and three outcomes determined 3 months after the initial ED visit were examined: post-concussive symptom (PCS) score (0, 1-5, 6-16, and >16), the number of days to return of normal activities (0, 1-7, and >7), and the number of days of work missed (0, 1-7,and >7). Logistic regression analyses were used to determine the relationship between sex and each outcome after controlling for 12 relevant subject-level variables. Of the 1425 subjects, 643 (45.1%) were female and 782 (54.9%) were male. Three months after mTBI, males had significantly lower odds of being in a higher PCS score category (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.50, 0.78); this association appeared to be more prominent during child-bearing years for females. Males and females did not significantly differ with respect to the odds of poorer outcome as defined by the number of days to return of normal activities or the number of days of work missed. Female sex is associated with significantly higher odds of poor outcome after mTBI, as measured by PCS score, after control for appropriate confounders. The observed pattern of peak disability for females during the child-bearing years suggests disruption of endogenous estrogen or progesterone production. Attempts to better understand how mTBI affects production of these hormones acutely after injury and during the recovery period may shed light on the mechanism behind poorer outcome among females and putative therapeutic interventions.

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Cerebral Hemodynamic Effects of Morphine and Fentanyl in Patients with Severe Head Injury: Absence of Correlation to Cerebral Autoregulation

Cited by 21 publications

References 0 publications

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

Cerebral Autoregulation is Influenced by Carbon Dioxide Levels in Patients with Septic Shock

Sex Differences in Outcome after Mild Traumatic Brain Injury

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