Trauma anesthesia and critical care of neurological injury

Colombian Journal of Anesthesiology, 2015

Traumatic Brain Injury (TBI) is a complex disease with a high social burden because of its high mortality and high rate of sequelae. Outcome after TBI is related to early management, including anesthetic management. In this article we review up to date concepts for anesthetic management of TBI patients; from pre-anesthetic evaluation to different aspects of surgical management: induction of anesthesia, airway control, mechanical ventilation, intravenous fluid management, maintenance of anesthesia during neurological and nonneurological surgery, and the treatment of brain edema, coagulopathy, electrolyte balance and temperature. We think the treatment must be directed to goals in order to offer the patient the best conditions for recovery and to avoid secondary brain injury.

European Archives of Medical Research, 2019

Anesthesia Management in Trauma Trauma, which means wound in ancient Greek, is the leading cause of death in the 1-44 age group, and the third cause of death following cancer and cardiovascular disease in all age groups. Trauma is defined as tissue damage characterized by structural changes and physiological disorders due to mechanical, thermal, electrical and chemical energies, ionized or nuclear radiation or absence of essential elements of life such as oxygen and heat. Trauma has many reasons such as traffic accidents, work accidents and falling from height (1,2). These patients need a systematic anesthesia management in posttraumatic evaluation, airway management, resuscitation, possible preoperative and postoperative surgical process, intensive care follow-up and treatment (3). The nature of trauma, uncontrollable bleeding after trauma, coagulation anomalies, hypothermia, shock, acidosis disrupt the normal homeostatic mechanism. Acute coagulopathy caused by high blood loss in major traumas is often associated with poor clinical course in trauma patients (4,5). Another paradox is the nature of unexplained events, insufficient anamnesis information and the necessity of emergency intervention in trauma cases. Initial Assessment of Trauma Algorithms have been defined for systemic approach to trauma patients and more than fifty scoring systems have been developed. The Trauma score, which was defined in 1981 by adding respiratory rate and systolic blood pressure to the Triage index, is a widely used scoring system. It was revised in 1989 and Revised Trauma score was formed (Table 1). In order for the trauma centers to systematically engage a modern trauma approach in harmony between the other disciplines, it is necessary to establish national guidelines tailored to the needs and ensure their widespread use. Airway obstruction, severe hemorrhage and hypoxia due to tension pneumothorax may be among the causes of early death due to trauma (6-8). From the moment the trauma patient is met, the first step is to apply the

Anesthesiology Clinics of North America, 1996

Journal of Neuroanaesthesiology and Critical Care, 2020

Journal of the Royal Army Medical Corps, 2010

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the headinjured patient the best chance of recovery.

1992

Approved for public release; Distribution unlimited The pediatric trauma patient presents unique problems. An overview as well as specific aspects in the management of closed head injury; initial resuscitation and transport of the injured child will be presented. Additionally, a "hands-on" mini-session on interosseous infusion will be presented. Symposium, Trauma, Anesthesia, RA 2 Unclassified Unclassified Unclassified Unlimited

International anesthesiology clinics, 1987

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2016

Introduction Head injury is a direct determinant of morbidity, disability, and mortality in the young population. Sedatives and analgesics are commonly used in patients with brain injury to retrieve an ICP, CMRO2, and CBF, preserving the cerebral regulation system and self-avoiding hypotension. Objective The objective of this paper is to review on this topic, linking the main drugs, side effects, costs, anxiolytic properties, anticonvulsants, and correlating them with complacency and brain metabolism. Methods We perform a literature review using PubMed database, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and Clinical trials. We selected papers from the period between 1958 and 2014, which totaled 254 papers. Of these, we selected 129 papers based on keywords, inclusion, and exclusion criteria. Evidence Review The volume of the brain decreases due to dislocation of the CBV out of the skull. The main sedatives and analgesics are propofol, midazolam, etomidate, ketamine, barbiturates, dexedetomedina, morphine, fentanyl, alfentanil, sulfenatil, and remifentanil. We hereby discuss the algorithm for a fast intubation sequence and the algorithm for intracranial hypertension treatment regarding the systematic sedation therapy. A range of sedatives and analgesic agents are available for sedation. Each class has its own positive and negative effects on neurotrauma patients.

1996

Abstract Severe traumatic brain injuries are extremely heterogeneous. At least seven of the secondary derangements in the brain that have been identified as occurring after most traumatic brain injuries also occur after cardiac arrest. These secondary derangements include posttraumatic brain ischemia. In addition, traumatic brain injury causes insults not present after cardiac arrest, ie, mechanical tissue injury (including axonal injury and hemorrhages), followed by inflammation, brain swelling, and brain herniation.

Anesthesiology Clinics of North America, 1999