By Georg E. Cold
During the decade a mess of stories in regards to the dynamic adjustments in cerebral blood move (CBF), cerebral metabolic cost of oxygen (CMRO2), and intracranial strain (ICP) within the acute part after head damage were released. those reports were supplemented with stories of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. different investigations comprise experiences of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. during this ebook experimental and scientific reports of the dynamic alterations in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's personal scientific reports of the dynamic adjustments in CBF and cerebral metabolism are summarized and mentioned, and the therapeutical implication as regards using synthetic hyperventilation, sedation with barbiturate and mannitol therapy are discussed.
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Extra info for Cerebral Blood Flow in Acute Head Injury: The Regulation of Cerebral Blood Flow and Metabolism During the Acute Phase of Head Injury, and Its Significance for Therapy
Broken lines and open circles indicate a poor clinical outcome (dementia, vegetative survival and death). Circles indicate patients with contusion or dilaceration. Squares indicate patients with brain-stem lesions without contusion or dilaceration of the hemispheres. Upper figure indicates an early hyperperfusion state in four repeated studies, one of which bilateral. Central figure indicates a late hyperperfusion state in 10 patients. The lower figure indicates a low perfusion state in three patients without hemispheric lesions but with lesion of the brainstem, and in four patients with hemispheric lesions (all with ages above 45 years) (Acta Anaesthesiol Scand 1980: 24: 245-251, with permission) In 10 patients, the maximal CBF was observed after the first day following the trauma.
Studies of Cerebral Autoregulation (CA) (Regional Studies) During acute increase in blood pressure the number of regions with tissue peaks increased (study IV). In regions with severe cerebral contusion the CA generally was lost (study IV). 6% of all regions and a 10% fall in rCBF was observed in 10% of all regions. The frequency of reciprocal reactions was unrelated to changes in ICP during angiotensin infusion (study IV). Studies of regional CA during two levels of PaCOz indicated that in regions with preserved COz reactivity the CA apparently was best preserved during moderate hypocapnia.
The Author's Own Studies CBF and CMR02 in the Acute Phase of Head Injury In the following nine studies done by the author of CBF and metabolism in the acute phase of HI are reviewed. Repeated studies of CBF in the acute phase after head injury (study V), cerebral metabolic rate of oxygen (CMR0 2) in the acute phase of head injury (study III), the relationship between CMR0 2 and CBF in the acute phase of head injury (study VII), studies of cerebral autoregulation (study IV), studies of the effect of two levels of induced hypocapnia on cerebral autoregulation (study VI), studies of the CO 2 reactivity during the acute phase (studies I, II, VIII, and IX), and studies of the barbiturate reactivity and CO 2 reactivity during the acute phase (study IX).
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