One of the central things we do for neuro patients in control their ICP. But, does tight control of ICP improve outcomes? Is ICP the best thing for us to be optimizing, especially if brain ischemia is what we're trying to avoid? What about brain tissue oxygenation? I'll quickly review the evidence, and you decide. Lundberg demonstrating ICP measured from an EVD in TBI patients. Lundberg, N., Troupp, H., Lorin, H. (1965). Continuous Recording of the...

Does Lasix work to control your ICP? Is it synergistic with mannitol? No. Oh, you want evidence? Fine... ech... Todd, M., Cutkomp, J., Brian, J. (2006). Influence of Mannitol and Furosemide, Alone and in Combination, on Brain Water Content after Fluid Percussion Injury Anesthesiology 105(6), 1176-1181. https://dx.doi.org/10.1097/00000542-200612000-00017

What is the evidence behind the things we are forced to wear in the OR? Do they help? Are they voodoo? On this episode, Karl takes us through the evidence behind the different pieces of OR attire. Some things seem to work... some things do nothing... some things might actually be harmful. 🤨 Literature Referenced: Overview of adoption of OR attire through history, by examining historical photographs. Adams, L., Aschenbrenner, C., Houle, T., Roy, R. (2016)....

Our inaugural TIA! (mini-episodes reviewing a specific article) This one is is discussing an article that measured awareness under anesthesia – more common than you might expect... Sanders, R., Gaskell, A., Raz, A., Winders, J., Stevanovic, A., Rossaint, R., Boncyk, C., Defresne, A., Tran, G., Tasbihgou, S., Meier, S., Vlisides, P., Fardous, H., Hess, A., Bauer, R., Absalom, A., Mashour, G., Bonhomme, V., Coburn, M., Sleigh, J. (2017). Incidence of Connected Consciousness after...

This episode we cover a brief overview of the history of neurosurgery, from ancient trephination through the contributions of Harvey Cushing in establishing the modern field. How far back were people doing surgery on the head? What was holding us back from doing real brain surgeries, and why did it not flourish until this century? Why was Harvey Cushing the perfect person to be the "father" of modern neurosurgery? References Used: Really good book (and not too long)...

How good are we at predicting outcome in severe TBI? Do all patients do bad, or are there some that recover? On this episode Karl dives into the data to give us an update on what the data supports. Literature Referenced: What early predictions do we make? Barlow, P., Teasdale, G. (1986). Prediction of Outcome and the Management of Severe Head Injuries: The Attitudes of Neurosurgeons Neurosurgery 19(6), 989-991....

Is ketamine safe to use in TBI patients (or anyone with increased ICP)? The usual answer is “heck no!”, but where does this come from, and is it true? This week, Karl and I talk about the origin of this believe and the evidence behind the safety of ketamine in TBIs (and how it might actually improve outcome...) Literature Referenced: Original Lancet letter that started everything. Four cases of increased ICP after ketamine administration. Evans, J.,...

Really? Decadron can worsen mortality in GBMs? This week Karl and I go over the evidence showing that steroids might not be the best thing for GBM patients. Specifically, it looks like dexamethasone might interfere with the effectiveness of chemo and radiation, leading to worse outcomes. Literature Referenced: Opinion paper that summarizes the argument against using Decadron in GBM patients: Wong, E., Swanson, K. (2019). Dexamethasone—Friend or Foe for...

Want a taste of what’s to come? The first full episode will be released shortly! Here’s something to tide you over…