Paroxysmal Sympathetic Hyperactivity

Fernández-Ortega, Juan Francisco; Garcia-Martinez, M.V.; Furones-Lorente, M.J.; Quesada-García, Guillermo; Prieto-Palomino, Miguel Angel

doi:10.1097/htr.0000000000000116

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…Previous experience holds that there is a sympathetic positive feedback loop in patients with long-term duration that is impossible to disrupt, making treatment all the more difficult (67). Last, it is important to consider the optimal choices in terms of timing, route, and cycle of treatment (65,68). Here, we classify treatment methods into two main types, pharmacologic and non-pharmacologic.…”

Section: Treatment Progressmentioning

confidence: 99%

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

et al. 2020

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Section: Treatment Progressmentioning

confidence: 99%

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

et al. 2020

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“…[23] Currently, beta-blockers, opioids, bromocriptine, and baclofen are the commonly used drugs to successfully alleviate PSH episodes. [24] Previous research on TBI patients treated with either DEX or propofol/midazolam found no significant between-group differences regarding the proportions of patients who met the “probable” or “possible” criteria, but more patients met the “unlikely” criteria in the DEX group compared to the propofol/midazolam group. [25] There have been no studies comparing the effect of DEX vs sufentanil on the alleviation of PSH episodes in TBI patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients

Gao

Wei

et al. 2019

Medicine

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Background:Percutaneous tracheostomy, almost associated with cough reflex and hemodynamic fluctuations, is a common procedure for traumatic brain injury (TBI) patients, especially those in neurosurgery intensive care units (NICUs). However, there are currently a lack of effective preventive measures to reduce the risk of secondary brain injury. The aim of this study was to compare the effect of dexmedetomidine (DEX) vs sufentanil during percutaneous tracheostomy in TBI patients.Methods:The 196 TBI patients who underwent percutaneous tracheostomy were randomized divided into 3 groups: group D1 (n = 62, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), group D2 (n = 68, DEX infusion at 1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), and group S (n = 66, sufentanil infusion 0.3 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.4 μg·kg–1·hour–1). The bispectral index (BIS) of all patients was maintained at 50 to 70 during surgery. Anesthesia onset time, hemodynamic variables, total cumulative dose of DEX/sufentanil, total doses of rescue propofol and fentanyl, time to first dose of rescue propofol and fentanyl, number of intraoperative patient movements and cough reflexes, adverse events, and surgeon satisfaction score were recorded.Results:Anesthesia onset time was significantly lower in group D2 than in both other groups (14.35 ± 3.23 vs 12.42 ± 2.12 vs 13.88 ± 3.51 minutes in groups D1, D2, and S, respectively; P < .001). Both heart rate and mean arterial pressure during percutaneous tracheostomy were more stable in group D2. Total doses of rescue propofol and fentanyl were significantly lower in group D2 than in group D1 (P < .001). The time to first dose of rescue propofol and fentanyl were significantly longer in group D2 than in both other groups (P < .001). The number of patient movements and cough reflexes during percutaneous tracheostomy were lower in group D2 than in both other groups (P < .001). The overall incidences of tachycardia and hypertension (which required higher doses of esmolol and urapidil, respectively) were also lower in group D2 than in both other groups (P < .05). Three patients in group S had respiratory depression compared to X in the D1 group and X in the D2 group. The surgeon satisfaction score was significantly higher in group D2 than in both other groups (P < .05).Conclusions:During percutaneous tracheostomy, compared with sufentanil, DEX (1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1) can provide the desired attenuation of the hemodynamic response without increased adverse events. Consequently, DEX could be used safely and effectively during percutaneous tracheostomy in TBI patients.

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“…Debido que el diagnóstico de HSP se basa en los hallazgos clínicos, los exámenes complementarios no son los instrumentos necesarios para detectar con certeza esta condición 3 . Además, en los diferentes estudios realizados, los criterios para diagnosticar la HSP han sido muy heterogéneos, dificultando este proceso 16 . Sin embargo, en el año 2014 se estableció una herramienta cuyo objetivo fue estandarizar estos criterios a modo que pueda emplearse en los centros asistenciales como método diagnóstico y orientación al manejo clínico de la HSP; esta herramienta se conoce como Medida de Evaluación de PSH (PSH-AM, por sus siglas en inglés).…”

Section: Criterios Diagnósticosunclassified

“…En diversos estudios, los valores elevados de catecolaminas o de otras hormonas, como las adrenocorticales, se han asociado a lesión traumática cerebral 2,16 . Dicho aumento de catecolaminas es proporcional a la gravedad del daño neurológico, lo cual puede relacionarse con la sintomatología de la HSP 2 .…”

Section: Influencia De Hormonasunclassified

“…En una de esas investigaciones se han comparado los valores de catecolaminas en un paciente con HSP en estado de reposo y a la hora de los paroxismos y se encontraron elevaciones de norepinefrina en un 60 y epinefrina en un 100% con respecto a los valores basales. Sin embargo, no se ha evaluado el impacto de los episodios de HSP en los ejes de hormonas tiroideas o adrenocorticales 16 .…”

Section: Influencia De Hormonasunclassified

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Hiperactividad simpática paroxística en lesión neurologica: revisión

et al. 2019

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La hiperactividad simpática paroxística es un fenómeno que se presenta en individuos, independientemente de su edad y sexo, posterior al daño cerebral. Es una respuesta fisiológica donde se ve actividad aumentada del sistema nervioso autónomo simpático, pero a su vez existe influencia hormonal, que se evidencia en las manifestaciones clínicas del paciente. Los neurocirujanos debemos identificar esta alteración en nuestros pacientes de una manera oportuna.

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Paroxysmal Sympathetic Hyperactivity

Cited by 4 publications

References 5 publications

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients

Hiperactividad simpática paroxística en lesión neurologica: revisión

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