Management of Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Primary brain injury occurs at the time of trauma due to external mechanical forces, while secondary brain injury occurs for hours to days after the trauma. The cornerstone of perioperative management lies in prevention of secondary brain injury by preventing elevated intracranial pressure (ICP), hypotension, hypoxia, hypo- or hypercarbia, hypo- or hyperglycemia, hyperthermia, seizures, and coagulopathy. The clinical severity of TBI is assessed by calculating the Glasgow Coma Scale score. Airway management can be challenging, and rapid sequence intubation is performed with manual inline stabilization. Cerebral autoregulation is disrupted, and anesthetic management should ensure adequate cerebral perfusion pressures of 60–70 mm Hg. ICP monitoring is frequently performed, and elevated ICP above 22 mm Hg is treated with head elevation, adequate analgesia and sedation, decreasing intrathoracic pressure, temporary hyperventilation, cerebrospinal fluid drainage, and osmotherapy. Postoperative mechanical ventilation and neuro–intensive care management are often required.