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Anesthesia Types Used in Combat Injuries Compared

Neuroanesthesia type used in surgery for combat-related brain trauma did not affect outcomes

WEDNESDAY, June 25 (HealthDay News) -- Total intravenous anesthesia, often including ketamine, did not produce better outcomes than volatile gas anesthesia in patients who underwent neurosurgery for combat-related traumatic brain injury, according to a report in the July issue of Anesthesiology.

LTC Kurt W. Grathwohl, M.D., of the Brooke Army Medical Center in San Antonio, Texas, and colleagues conducted a retrospective study of the impact of two kinds of neuroanesthesia on outcomes in patients who underwent surgery for combat-related traumatic brain injury: volatile gas (120 patients), and total intravenous anesthesia (94 patients) including, in many cases, the anesthetic ketamine. Outcomes were measured based on mortality rates and the Glasgow Outcome Score, administered at discharge.

While intravenous anesthesia patients had better outcomes, including decreased mortality, these results did not hold after adjusting for confounding factors, including the time and type of surgical procedure (craniectomy or craniotomy), and severity of injury, the investigators found. In a sub-analysis, the researchers found that using ketamine in intravenous anesthesia did not change outcomes.

"Confounding variables associated with injury severity and temporal periods significantly limited our ability to make definitive conclusions regarding the outcomes we studied," the authors warned. "Given the potential widespread effects of the improvements in neurological outcomes of this anesthetic strategy, we believe that further prospective evaluation is needed to determine if outcome related differences exist."

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