REVIEW   Free access

Minerva Anestesiologica 2022 May;88(5):380-9

DOI: 10.23736/S0375-9393.21.15927-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Perioperative management of severe brain injured patients

Edoardo PICETTI ¹ ✉, Pierre BOUZAT ², Luca CATTANI ¹, Fabio S. TACCONE ³

¹ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy; ² Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble Alpes University Hospital, Grenoble, France; ³ Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

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.

KEY WORDS: Brain injuries, traumatic; Intracranial hypertension; Neurosurgery