Perioperative Management of Traumatic Brain Injury
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Purpose of Review
Traumatic brain injury (TBI) is a global public health problem. It is increasingly being recognized as a progressive disease in which intrinsic pathophysiologic processes and systemic secondary insults aggravate the primary brain damage. The perioperative period is crucial in the continuum of the management of TBI. This review summarizes current anesthetic strategies to optimize TBI outcomes.
Perioperative data on TBI management are limited. However, recent findings indicate that intraoperative secondary insults are common and are associated with worse outcomes after intracranial as well as extracranial surgery in patients with TBI. The choice of anesthetic agents has not been shown to impact that the neurologic outcomes are TBI.
Perioperative therapeutic goals for patients with TBI include facilitating early cerebral decompression, providing balanced anesthesia for surgery, maintaining adequate cerebral perfusion by optimizing systemic and intracranial hemodynamics, and aggressively avoiding secondary insults. Intensive multimodal monitoring of the brain provides vital information that may be helpful in individualizing therapy; such monitoring should be continued in the perioperative period, particularly during extracranial surgery in TBI patients with polytrauma. While further investigation to characterize the impact of anesthetic agents on the injured brain and their effect on clinical outcomes is awaited, perioperative management should focus on adherence to consensus guidelines.
KeywordsTraumatic brain injury Anesthesia Perioperative Secondary insult
Compliance with Ethics Guidelines
Conflict of Interest
Nelson Nicolas Algarra and Deepak Sharma declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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