Anesthesiology pp 597-604 | Cite as

Perioperative Management of Adult Patients with Severe Head Injury

  • Adam LowEmail author


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.


Traumatic brain injury Neuroanesthesia Critical care Intra-cranial pressure 


  1. 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.CrossRefGoogle Scholar
  2. 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. 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. Scholar
  4. 4.
    Dinsmore J. Traumatic brain injury: an evidence based review of management. Contin Educ Anaesth Crit Care Pain. 2013;13(6):189–95.CrossRefGoogle Scholar
  5. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 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. Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Algara NN, Sharma D. Perioperative management of traumatic brain injury. Curr Anesthesiol Rep. 2016;6:193–201.CrossRefGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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. 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Carney N, Totten AM, O’Reilly C. Guidelines for the management of severe traumatic brain injury. 4th ed. Brain Trauma Foundation 2016 at:
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Hospital BirminghamBirminghamUK

Personalised recommendations