Anesthetic management of severe head injury

Abstract

Traumatic brain injury (TBI) is a major public health concern. Emergency surgery for TBI is performed frequently. A multidisciplinary approach may be needed, as TBI can often be just one element of polytrauma. Secondary cerebral injuries are also common after TBI and are caused by post-insult physiologic derangements. The main goals of the anesthetic management of TBI are to facilitate early decompression, provide adequate analgesia and anesthesia, maintain adequate cerebral perfusion, treat intracranial hypertension, provide optimal surgical conditions, and prevent secondary insults such as hypoxemia, hyper-and hypocarbia, and hypo-and hyperglycemia. Resuscitation of polytrauma including hemostasis by transcatheter arterial embolization and/or surgical hemostasis must be considered. The perioperative period is a critical window of opportunity in which anesthesiologists can prevent and reduce the burden of secondary brain injury after TBI. The choice of anesthetic strategy is guided by the influence of anesthetic agents and interventions on the pathophysiologic processes provoked by TBI.