Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

On the Academic Value and Influence of Wang Hao-gu’s ‘Yinzheng Lueli’

The magnum opus of the famous physician Wang Haogu in the Yuan Dynasty,"Yinzheng Lueli(Brief Examples of Yin Syndromes)",invented the"Yin Syndrome"theory based on"The Treatise on Febrile Diseases",systematically discussed the theory of"cold drinking leads to internal injury",and advocated the treatment of warm tonifying the spleen and kidney rather than heat tonification,initiated the study of"warm tonification"in the subsequent Ming and Qing Dynasties.These have played an important role in the inheritance and advancement of the Yishui School,and also have a profound impact on the Chinese medicine theory and the diagnosis and treatment of diseases in later generations.

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

The occurrence, bleeding, and treatment of internal mammary artery（IMA） injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.

Impact of hospital type on risk-adjusted,traffic-related 30-day mortality:a population-based registry study

Background:Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality.The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.Methods:Data on all patients admitted to Swedish hospitals with traffic-related injuries,based on International Classification of Diseases codes,between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries.Using the binary outcome measure of death or survival,data were analysed using logistic regression,adjusting for age,sex,comorbidity,severity of injury and hospital type.The severity of injury was established using the International Classification of Diseases Injury Severity Score(ICISS).Results:The final study population consisted of 152,693 hospital admissions.Young individuals(0–25 years of age)were overrepresented,accounting for 41%of traffic-related injuries.Men were overrepresented in all age categories.Fatalities at university hospitals had the lowest mean(SD)ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.The crude overall mortality in the study population was 1193,with a mean ICISS 0.72(0.17).Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals,no significant difference was found.A comparison between hospital groups with the most severely injured patients(ICISS0.85)also did not show a significant difference(odds ratio,1.13;95%confidence interval,0.97–1.32).Conclusions:This study shows that,in Sweden,the type of hospital does not influence risk adjusted traffic related mortality,where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.