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Stanlies Dsouza

Stanlies Dsouza

University of Massachusetts Medical School, United States

Title: Target Blood Pressure in Neurosurgical Patients: How high and how low we should go?

Biography

Biography: Stanlies Dsouza

Abstract

General concepts

  1. Lower limit of  of mean arterial pressure(MAP) in neurosurgical patients: current concepts
  2. Pathophysiology of systemic hypertension as per current literature
  3. Pathophysiology of systemic cardiovascular and pulmonary events as current literature
  4.  Status of cerebral autoregulation  and blood brain integrity following an intracranial event 
  5. Management of systemic hypertension: Choice of pharmacological agents  as per current concepts
  6. Reasons for avoiding vasodilator agents to treat systemic hypertension
  7.  Role of routine cardiac evaluation in a patient with acute intracranial pathology
  8. Role of perioperative prophylactic  beta blockers to treat systemic hypertension and cardiac pathology in a patient with intracranial pathology
  9. Laboratory monitoring of hypertensive response following intracranial event as per current evidence.

Target blood Traumatic Brain Injury (TBI)

  1. Definition of hypotension in TBI and why the lower limit of hypotension was increased from 90 to 110 mm Hg as per 2016 Brain Trauma Foundation(BTF) guidelines
  2. Target cerebral perfusion Pressure (CPP) as per recent BTF guidelines and why the target CPP is narrowed in recent BTF guidelines. Definition of lower and upper limit of CPP in TBI.
  3. Method of calculation of target MAP in the absence of ICP monitor for an emergent TBI patient coming craniotomy. Discussion about lower and upper level of MAP.
  4. Harmful effects of the rise and fall of CPP above and below this narrow range of CPP.

Target BP in acute ischemic stroke(AIS)

  1. Review of literature of target systolic BP range prior to reperfusion therapy in AIS.

Target BP in spontaneous intracerebral hemorrhage

  1. Review of INTERACT 2 and ATTACH2 trials.
  2. Target BP based on above 2 trials as per neurological outcome

 

Target BP in aneurysmal subarachnoid hemorrhage (aSAH)

  1. Historical target for BP in aSAH.
  2. Review of  Neurocritical care society consensus statement 2011 on target BP for patients  presenting clipping, coiling or endovascular flow diversion for techniques.
  3. Review of the American Stroke Association (ASA) of the  American Heart Association(AHA) guidelines for aSAH blood pressure targets.
  4. Extrapolation of results of spontaneous ICH trials to spontaneous aSAH.
  5. Target BP during application of a temporary clip.
  6. Target  BP during induced hypotension for permanent clip.
  7. Target BP for induced hypertension for DCI. afteraSAH.

 Target BP for Deep Brain stimulation electrode implantation 

  1. Target BP range  during  permanent macroelectrode and microelectrode implantation
  2. Reasons for this blood pressure target as per current evidence
  3. Which antihypertensive agents should be avoided during permanent  Deep Brain Stimulation electrodes ?Why?