Pentobarbital Coma in Neurosurgical Patients: Nutrition Considerations

Magnuson, Barbara; Hatton, Jimmi; Zweng, Thomas N.; Young, Byron

doi:10.1177/0115426594009004146

Cited by 16 publications

(15 citation statements)

References 36 publications

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“…The level of metabolism in the injured brain can increase from 32% to 200% depending on the severity of the injury . Even in the most severe cases of TBI where a patient is placed into a barbiturate coma for neuroprotection by reducing cerebral metabolism, the cerebral metabolic demand is still 100%–120% greater than resting baseline energy expenditures . A systemic hyper‐metabolic state occurs in TBI with a depletion of whole body energy stores .…”

Section: Techniquementioning

confidence: 99%

“…44 Even in the most severe cases of TBI where a patient is placed into a barbiturate coma for neuroprotection by reducing cerebral metabolism, the cerebral metabolic demand is still 100%-120% greater than resting baseline energy expenditures. 45 A systemic hypermetabolic state occurs in TBI with a depletion of whole body energy stores. 46 The healing neurosurgical wound from a craniotomy incision competes with cerebral and systemic metabolic consumption, which can deprive the wound from receiving adequate nutritional support.…”

Section: Nutritionmentioning

confidence: 99%

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The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes

Berry

Miulli

Lam

et al. 2018

International Wound Journal

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Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.

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Section: Techniquementioning

confidence: 99%

Section: Nutritionmentioning

confidence: 99%

The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes

Berry

Miulli

Lam

et al. 2018

International Wound Journal

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“…Adequate “anchoring” of the tube is essential. One method by which this may be accomplished is by bridling the tube 21 . Endoscopic feeding tube placement may also be perilous, particularly early after injury or in patients with ICP elevations 23 .…”

Section: Enteral Nutrition Accessmentioning

confidence: 99%

“…Although potential feeding difficulties are present in many TBI patients, safe, efficient, and adequate EN can be provided in the majority of these individuals 87 , 88 . Several strategies can be used to increase feeding tolerance in TBI patients 20 , 21 . First, elevating the head of the bed by 30 to 45 degrees is a well established practice and a grade I recommendation to decrease reflux of gastric contents into the pharynx and esophagus 24 .…”

Section: Facilitating Enteral Nutrition Tolerancementioning

confidence: 99%

“…18,19 TBI patients often exhibit impaired gastric emptying due to vagus nerve damage, elevated levels of endogenous opioids and endorphins, or medications such as pentobarbital or narcotics. 20,21 Elevated ICP has been associated with feeding intolerance as well. 20 Nasally-inserted small bowel feeding access devices are generally safe and easily inserted at the bedside by a nurse.…”

Section: Enteral Nutrition Accessmentioning

confidence: 99%

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Nutrition Considerations in Traumatic Brain Injury

2008

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The provision of adequate nutrition support for patients with traumatic brain injury (TBI) has been a clinical challenge for decades. The primary and secondary injuries create unique metabolic derangements along with accompanying issues such as optimal timing and route of nutrition, appropriate fluid and electrolytes, drug administration, rehabilitation, and dysphagia. Enteral nutrition is clearly established as the preferential route of nutrition support for this population vs parenteral nutrition. There appears to be a consensus on early initiation of enteral nutrition, but less definitive are recommendations on advancement timing and formula components. Nutrition therapies should include exact fluid resuscitation goals specific for TBI and strict electrolyte monitoring to avoid extreme fluid, electrolyte, or glucose shifts that could be detrimental to the patient. While the critical care patient often tolerates small bowel feeding, the long-term rehabilitation patient should transition to and tolerate gastric feeding. Drug-nutrient and adverse drug reactions such as diarrhea should be routinely evaluated in patients receiving enteral nutrition. Monitoring for dysphagia is critical to avoid the costly negative aspects associated with aspiration and to capitalize on quality of life and appropriate oral nutrition. Emphasizing the priority of early nutrition support within a multi-disciplinary team may be the critical key for successful provision and tolerance of nutrition support in the TBI population.

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