Perioperative management of severe brain injured patients

Minerva Anestesiol. 2022 May;88(5):380-389. doi: 10.23736/S0375-9393.21.15927-9. Epub 2021 Oct 12.

Abstract

Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery; and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.

Publication types

  • Review

MeSH terms

  • Brain / physiopathology
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / surgery
  • Brain Injuries, Traumatic / therapy*
  • Emergencies
  • Humans
  • Intracranial Hypertension / therapy*
  • Neurosurgery* / methods
  • Neurosurgery* / standards
  • Postoperative Care / methods
  • Postoperative Care / standards
  • Preoperative Care / methods
  • Preoperative Care / standards