title: Therapeutic hypothermia and inhalation anesthesia in a patient with severe pneumococcal meningitis and secondary cardiac arrest.
abstract: Therapeutic hypothermia was associated with increased mortality in patients with severe bacterial meningitis in a large randomized trial. It still remains a treatment strategy for comatose survivors of cardiac arrest. There are several potential advantages of inhalational anesthetics as long-term sedation agents compared to intravenous sedation, however, uncontrollable increases of intracranial pressure were observed in neurocritical patients. Here we present a patient with severe bacterial meningitis and secondary cardiac arrest where therapeutic hypothermia and inhalational anesthesia were successfully used. A 59-year old female with a history of a vestibular Schwannoma surgery on the left side was admitted with signs of meningitis. Within minutes after admission, she further deteriorated with respiratory arrest, followed by cardiac arrest. She remained comatose after return of spontaneous circulation. The standard treatment of severe meningitis (steroids, antibiotics, insertion of intracranial pressure probe and external ventricular drainage) along with therapeutic hypothermia and inhalational anesthesia were implemented. Intracranial pressure remained stable and daily neurological examination was possible without being confounded by concurrent sedation. She was discharged home without neurological sequelae after 27days. In selected patients with meningitis, therapeutic hypothermia may still present a treatment option, and the long-term use of inhalational anesthetics could be appropriate with concomitant intracranial pressure monitoring.
authors.affiliation: Division of Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia. Electronic address: nejc.bukovnik@gmail.com.
authors.forename: Nejc
authors.initials: N
authors.lastname: Bukovnik
authors.affiliation: Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
authors.forename: Andrej
authors.initials: A
authors.lastname: Markota
authors.affiliation: Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia.
authors.forename: Tomaž
authors.initials: T
authors.lastname: Velnar
authors.affiliation: Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
authors.forename: Janez
authors.initials: J
authors.lastname: Rebol
authors.affiliation: Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
authors.forename: Andreja
authors.initials: A
authors.lastname: Sinkovič
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000769:Anesthesia, Inhalation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004322:Drainage; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007427:Intracranial Pressure; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000628:therapy*; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012720:Severity of Illness Index; D000077149:Sevoflurane
chemical_list: D000305:Adrenal Cortex Hormones; D018685:Anesthetics, Inhalation; D000900:Anti-Bacterial Agents; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: Cardiac arrest, secondary; Hypothermia, induced; Meningitis, bacterial; Sevoflurane