General anesthesia in patient with Brain Injury

Abstract

The basic concept of Neuroanesthesia & Neuro Critical Care is referred to as the ABCDE of neuroanesthesia. Early Brain Injury (EBI) was formerly known as primary brain injury. In EBI there is a loss of autoregulation and loss of blood-brain barrier integrity. The presence of Cushing's triad indicates the presence of intracranial hypertension. The target of blood pressure in traumatic brain injury (TBI) is to avoid blood pressure systolic <110 mmHg, maintain cerebral perfusion pressure (CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35–40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post-traumatic seizures (late PTS). There is still a need to analyse decompressive craniectomy (DECRA) therapy compared with continued medical therapy for refractory intracranial pressure (ICP) elevations after TBI. General anesthesia for patients with severe TBI is preferable to total intravenous anesthesia (TIVA), the administration of fluids should consider the osmolarity of these fluids. In the new concept, in patients with elevated ICP, the volatile anesthetic concentration should be limited to 0.5 MAC. The target blood sugar is normoglycemia. Prophylactic or therapeutic hypothermia appears to have no place in the management of severe brain injury