Through evolving research, recent years have witnessed remarkable achievements in neuromonitoring and neuroanesthetic techniques, with a huge body of literature consisting of excellent studies in neuroanaesthesiology. However, little of this work appears to be directly important to clinical practice. Many controversies still exist in care of patients with neurologic injury. This review discusses studies of great clinical importance carried out in the last five years, which have the potential of influencing our current clinical practice and also attempts to define areas in need of further research. Relevant literature was obtained through multiple sources that included professional websites, medical journals and textbooks using key words "neuroanaesthesiology," "
traumatic brain injury," "aneurysmal subarachnoid haemorrhage," "
carotid artery disease," "brain protection," "glycemic management" and "neurocritical care." In head injured patients, administration of
colloid and pre-hospital hypertonic saline
resuscitation have not been found beneficial while use of multimodality monitoring, individualized optimal cerebral perfusion pressure
therapy,
tranexamic acid and
decompressive craniectomy needs further evaluation. Studies are underway for establishing cerebroprotective potential of
therapeutic hypothermia. Local anaesthesia provides better neurocognitive outcome in patients undergoing
carotid endarterectomy compared with general anaesthesia. In patients with aneurysmal subarachnoid haemorrhage, induced
hypertension alone is currently recommended for treating suspected
cerebral vasospasm in place of triple H
therapy. Till date,
nimodipine is the only
drug with proven efficacy in preventing
cerebral vasospasm. In neurocritically ill patients, intensive
insulin therapy results in substantial increase in
hypoglycemic episodes and mortality rate, with current emphasis on minimizing
glucose variability. Results of ongoing multicentric trials are likely to further improvise our practice.