Skip to main content

Perioperative Management of Adult Patients with Severe Head Injury

  • Chapter
  • First Online:
Anesthesiology

Abstract

Traumatic brain injury remains a significant cause of death and disability worldwide. The term severe traumatic brain injury encompasses such a heterogenous group of injuries that in itself can be difficult to define. As such, each patient warrants individual consideration based upon the mechanism of injury, neurological deficit and radiological findings. The perioperative management for severe brain injury remains broadly the same irrespective of anatomical site of injury, namely the prevention of further injury to vulnerable neighbouring neural tissue. Attention to detail, appreciation of monitoring modalities and their limitation and the current evidence base for perioperative management are integral to patient outcome and outlined in the chapter below.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

    Book  Google Scholar 

  2. National Institute for Health and Clinical Excellence: Guidance. Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults. London: National Institute for Health and Care Excellence (UK); 2014.

    Google Scholar 

  3. Kehoe A, Smith JE, Edwards A, Yates E, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32:911–5. https://doi.org/10.1136/emermed-2015-205265.

    Article  PubMed  CAS  Google Scholar 

  4. Dinsmore J. Traumatic brain injury: an evidence based review of management. Contin Educ Anaesth Crit Care Pain. 2013;13(6):189–95.

    Article  Google Scholar 

  5. Peeters W, Van Den Bande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015;157(10):1683–96.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lawrence T, Helmy A, Boumra O, et al. Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality. BMJ Open. 2016;6(11):e012197. https://doi.org/10.1136/bmjopen-2016-012197.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Kehoe A, Smith JE, Boumara O, Woodford M, Lecky F, Hutchinson PJ. Older patients with traumatic brain injury present with higher GCS score than younger patients for a given severity of injury. Emerg Med J. 2016;33:381–5.

    Article  PubMed  CAS  Google Scholar 

  8. Malec JF, Brown AW, Leibson CL, Flaada JT, Mandrekar JN, Diehl NN, et al. The mayo classification system for traumatic brain injury severity. J Neurotrauma. 2007;24(9):1417–24.

    Article  PubMed  Google Scholar 

  9. McHugh GS, Engel DC, Butcher I, Steyerberg EW, Lu J, Mushkudiani N, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:287–93.

    Article  PubMed  Google Scholar 

  10. Nangunoori R, Maloney-Wilensky E, Stiefel M, Park S, Kofke A, Levine JM, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review. Neurocrit Care. 2012;17(1):131–8.

    Article  PubMed  CAS  Google Scholar 

  11. Pietropaoli JA, Rogers FB, Shackford SR, Wald SL, Schmoker JD, Zhuang J. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma. 1992;33:403–7.

    Article  PubMed  CAS  Google Scholar 

  12. Sharma D, Brown MJ, Curry P, Noda S, Chesnut RM, Vavilala MS. Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury. J Neurosurg Anesthesiol. 2012;24:178–84.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Algara NN, Sharma D. Perioperative management of traumatic brain injury. Curr Anesthesiol Rep. 2016;6:193–201.

    Article  Google Scholar 

  14. Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury outcomes at 6 months. Lancet. 2005;365:1957–9.

    Article  PubMed  Google Scholar 

  15. Klose M, Juul A, Struck J, Morgenthaler NG, Kosteljanetz M, Feldt-Rasmussen U. Acute and long term pituitary insufficiency in traumatic brain injury: a prospective single centre study. Clin Endocrinol. 2007;4:598–606.

    Google Scholar 

  16. Yuan Q, Wu X, Sun Y, Yu J, Li Z, Du Z, et al. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. J Neurosurg. 2015;122(3):574–87.

    Article  PubMed  Google Scholar 

  17. Carney N, Totten AM, O’Reilly C. Guidelines for the management of severe traumatic brain injury. 4th ed. Brain Trauma Foundation 2016 at: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf.

  18. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka A, Timothy J, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375:1119–30.

    Article  PubMed  Google Scholar 

  19. Skolnick SE, Maas AI, Narayan RK, van der Hoop RG, MacAllister T, Ward JD, et al. A clinical trial of progesterone for severe traumatic brain injury. N Engl J Med. 2014;371:2467–76.

    Article  CAS  PubMed  Google Scholar 

  20. Andrews PJD, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, et al. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015;373:2403–12.

    Article  CAS  PubMed  Google Scholar 

  21. Nichol A, French C, Little L, Haddad S, Presneill J, Arabi Y, et al. Erythropoietin in traumatic brain injury (EPO-TBI): a double blind randomised controlled trial. Lancet. 2015;386:2499–506.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adam Low MbCHB, F.R.C.A. Dip IMC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Low, A. (2018). Perioperative Management of Adult Patients with Severe Head Injury. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_62

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74766-8_62

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics