Trauma Anesthesia for Traumatic Brain Injury

Conti, Bianca; Villacin, M. Karla; Simmons, Jeffrey W.

doi:10.1007/s40140-016-0141-1

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…54 Traumatic brain injury patients release large amounts of tissue thromboplastin into their circulation, compounding coagulopathy. 55 Burn patients develop an acute burn induced coagulopathy. 56 Finally, an increasing number of trauma patients are found to be taking anticoagulants for a variety of medical disorders.…”

Section: Massive Transfusion Triggersmentioning

confidence: 99%

Acute traumatic coagulopathy: pathophysiology and resuscitation

Simmons

Powell

2016

British Journal of Anaesthesia

131

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Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes. We review normal coagulation using the cell-based model of haemostasis and the pathophysiology of acute traumatic coagulopathy. Developed trauma systems reduce mortality, highlighting critical goals for the trauma patient in different phases of care. Once patients reach a trauma hospital, certain triggers reliably indicate when they require massive transfusion and specialized trauma care. These triggers include base deficit, international normalized radio (INR), systolic arterial pressure, haemoglobin concentration, and temperature. Early identification for massive transfusion is critically important, as exsanguination in the first few hours of trauma is a leading cause of death. To combat derangements caused by massive haemorrhage, damage control resuscitation is a technique that addresses each antagonist to normal haemostasis. Components of damage control resuscitation include damage control surgery, permissive hypotension, limited crystalloid administration, haemostatic resuscitation, and correction of hyperfibrinolysis.

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Section: Massive Transfusion Triggersmentioning

confidence: 99%

Acute traumatic coagulopathy: pathophysiology and resuscitation

Simmons

Powell

2016

British Journal of Anaesthesia

131

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“…1 Dilaporkan sebanyak 1,7 juta orang mengalami COT setiap tahunnya di Amerika Serikat dengan penyebab utama adalah kecelakaan kendaraan bermotor. 2 Coronavirus disease (COVID-19) merupakan penyakit yang disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Penyakit ini menjadi pandemi global sejak 11 Maret 2020 dengan jumlah kasus hingga tanggal 1 November 2021 sebesar 248.676.412 kasus.…”

Section: Pendahuluanunclassified

“…14,15 Penanganan dalam periode perioperatif penting karena pembedahan dan anestesi membuat pasien rentan mengalami onset baru cedera sekunder, dan pada periode perioperatif juga, dapat dideteksi adanya cedera sekunder yang belum terdeteksi sebelumnya dan harus dikoreksi, untuk mencegah cedera otak sekunder yang baru dan memperbaiki luaran pasien. 2,14 Pencegahan cedera sekunder pada pasien dengan COVID-19 harus lebih diperhatikan karena adanya kemungkinan pasien sudah mengalami hipoksemia akibat ARDS. 5 Pemeriksaan AGD pada pasien ini menunjukkan PaO 2 87 mmHg dengan FiO 2 100%, namun SpO 2 masih menunjukkan 100%.…”

Section: Diagnosis Covid-19unclassified

Tatalaksana Anestesi pada Pasien dengan Perdarahan Epidural dan Infeksi COVID-19

Widiastuti

Halimi

Prihatno

et al. 2022

JNI

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Cedera otak traumatik (COT) masih menjadi masalah kesehatan utama di seluruh dunia. Meskipun terjadi penurunan angka kejadian COT saat pandemi COVID-19 karena mobilisasi yang dibatasi, namun karena keterbatasan akses ke fasilitas kesehatan, penanganan COT menjadi terlambat. Penanganan pasien COT dengan infeksi COVID-19 berbeda karena adanya protokol dan pertimbangan yang harus dilakukan untuk keselamatan tenaga medis dan kelancaran penanganan pasien. Laporan kasus ini mengenai laki-laki berusia 41 tahun datang dengan penurunan kesadaran pasca kecelakaan kendaraan bermotor 24 jam sebelum masuk rumah sakit (RS). Pasien merupakan rujukan dari RS lain dengan cedera kepala berat. Dari hasil Computed Tomography (CT) scan kepala didapatkan epidural hematoma (EDH) akut frontal kiri – frontal kanan parasagital yang menekan lobus frontal kiri – lobus frontal kanan parasagital dengan midline shift sejauh ± 1.35 cm. Hasil pemeriksaan screening menunjukan hasil swab PCR positif. Pasien awalnya akan dirujuk ke RS rujukan COVID-19 namun tidak berhasil mendapatkan rujukan. Perdarahan epidural merupakan kondisi yang mengancam nyawa sehingga tindakan harus segera dilakukan. Pasien menjalani operasi emergensi kraniotomi evakuasi EDH dalam anestesi umum dengan protokol COVID-19. Penanganan anestesi dengan memperhatikan COVID-19 dan implikasinya pada pasien, neuroanestesi, dengan tetap menerapkan protokol COVID-19

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“…Fungsi ginjal yang menurun menyebabkan pasien geriatri rentan terhadap asidosis metabolik hiperkloremik jika menggunakan banyak cairan NaCl 0,%. 14,18 D: Drugs Gunakan obat-obat yang memiliki efek neuroproteksi, seperti propofol, fentanyl, rocuronium. Saat induksi, pemberian obat bertujuan untuk menghindari kenaikan tekanan darah dan TIK, namun perlu diberikan secara titrasi untuk mencegah depresi kardiovaskular yang berlebihan pada geriatri.…”

Section: Evaluasi Preoperasiunclassified

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

Widiastuti

Rachman

Umar

2022

JNI

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Worldwide, the incidence of traumatic brain injury in geriatrics is 7–34%, with falls as the most common cause. Subdural hemorrhage is the most common injury that occur and is associated with the aging process of the brain, making geriatric patients prone developing subdural hemorrhage. A 72-years-old female came with a headache after fell to the ground 6 days before hospital admission. Physical examination revealed E3M5V6 without neurologic deficits and hemodynamically stable. A computed tomography scan resulted in subdural hematoma in right frontotemporoparietal region causing midline shifting to the left, subarachnoid hemorrhage in the left frontal region, intracerebral hemorrhage in the left temporal lobe. The patient underwent craniotomy evacuation of hematoma and lasted for 3 hours under general anesthesia. Anesthetic concerns are neuroanesthesia and geriatric patient considering the aging process affects physiologic and pharmacologic changes, comorbidities and polypharmacy. Comprehensive perioperative management is essential to prevent secondary brain injury and improve the outcome.

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Trauma Anesthesia for Traumatic Brain Injury

Cited by 4 publications

References 34 publications

Acute traumatic coagulopathy: pathophysiology and resuscitation

Acute traumatic coagulopathy: pathophysiology and resuscitation

Tatalaksana Anestesi pada Pasien dengan Perdarahan Epidural dan Infeksi COVID-19

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

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