DOI: 10.33962/roneuro-2022-063 Commentary: Controlling high blood pressure with intravenous sedation in mechanically ventilated neurosurgical patients in the intensive care unit. Is it a correct practice? Ebtesam Abdulla, Bassam Al-Aradi, Sabrina Rahman, Md Moshiur Romanian Neurosurgery (2022) XXXVI (3): pp. 370-371 DOI: 10.33962/roneuro-2022-063 www.journals.lapub.co.uk/index.php/roneurosurgery Commentary: Controlling high blood pressure with intravenous sedation in mechanically ventilated neurosurgical patients in the intensive care unit. Is it a correct practice? Ebtesam Abdulla1, Bassam Al-Aradi1, Sabrina Rahman2, Md Moshiur3 1 Department of Neurosurgery, Salmaniya Medical Complex, Manama, BAHRAIN 2 Department of Public Health, Independent University Bangladesh, Dhaka, BANGLADESH 3 Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, BANGLADESH ABSTRACT This commentary discusses the effect of misuse of intravenous sedation regimens in lowering the systemic blood pressure in mechanically ventilated neurosurgical patients in the intensive care unit. Intravenous sedation regimens are widely used in a neuro-intensive care unit (neuro-ICU) for specific neurologic purposes.1-4 Among these purposes are intracranial pressure control, seizures management, targeted temperature management, reduction of pain, agitation control, and patient-ventilatory asynchrony.1-4 The effect of sedatives on blood pressure is that they lower systemic blood pressure.5 Thus, some would intensify sedation intending for systemic blood pressure control.5 The problem is, when the sedatives are stopped, the risk of systemic rebound hypertension will exacerbate intracranial pressure in patients with low brain compliance.6 Improper management of systemic blood pressure (BP) can ultimately lead to encephalopathy, cardiac and renal complications.7,8 Moreover, the misuse of sedatives in neurocritical patients has deleterious effects in terms of eliminating neuro-assessment and potential cardiovascular depression; thus, it increases hospital stay, morbidity, mortality and delays the clinical decision process.1-4 Keywords hypertension, neuroICU, sedation Corresponding author: Ebtesam Abdulla Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain Dr.Ebtesam@hotmail.com Copyright and usage. This is an Open Access article, distributed under the terms of the Creative Commons Attribution Non–Commercial No Derivatives License (https://creativecommons .org/licenses/by-nc-nd/4.0/) which permits non- commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of the Romanian Society of Neurosurgery must be obtained for commercial re-use or in order to create a derivative work. ISSN online 2344-4959 © Romanian Society of Neurosurgery First published September 2022 by London Academic Publishing www.lapub.co.uk http://www.lapub.co.uk/ 371 Controlling high blood pressure with intravenous sedation Prompt BP control in mechanically ventilated patients with neurological emergencies in neuro-ICU is necessary.7-10 Nicardipine, labetalol, clevidipine, and urapidil are examples of fast-acting, soluble intravenous medicines that are feasible and recommended as first-line antihypertensive medications.8 Invasive BP monitoring is required, especially in the setting of intracranial hypertension.8,9 The 2013 American Stroke Association (ASA) guidelines state no exact BP target for which intravenous antihypertensive agents should be started.10 When the systolic BP surpasses 220 or the diastolic BP surpasses 120 during the first 24 hours after an acute ischemic stroke, the ASA recommends reducing the blood pressure.10 When fibrinolytic therapy is attempted, the recommended BP target is a systolic BP less than 180 or diastolic BP less than 110.10 REFERENCES 1. 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