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Anesthesia for patients with acute traumatic brain injury

Deepak Sharma, MBBS, MD, DM
Pratik V Patel, MD
Section Editor
Jeffrey J Pasternak, MD
Deputy Editor
Marianna Crowley, MD


Patients with severe traumatic brain injury (TBI) frequently have other traumatic injuries to internal organs, lungs, limbs, or the spinal cord. Thus, the management of the patient with severe TBI is often complex and requires a multidisciplinary approach.

Anesthesiologists are involved in the care of patients with TBI in various situations, including but not limited to: resuscitation and stabilization in the emergency department (ED), sedation and anesthesia for diagnostic imaging, craniotomy or decompressive craniectomy, extracranial surgery, and intensive care management.

Surgery and anesthesia may subject the injured brain to new, secondary injuries as a result of hypotension, hypoxemia, hypo- or hypercarbia, fever, hypo- or hyperglycemia, and/or increased intracranial pressure (ICP) that may adversely impact outcome.

This topic will discuss the intraoperative anesthetic management of patients with acute TBI. Epidemiology and pathophysiology, prehospital management, general concerns for anesthesia for craniotomy, and anesthesia for acute spinal cord injury are discussed separately. (See "Management of acute severe traumatic brain injury" and "Anesthesia for craniotomy" and "Traumatic brain injury: Epidemiology, classification, and pathophysiology" and "Anesthesia for adults with acute spinal cord injury" and "Anesthesia for adult trauma patients".)


The goal for preoperative evaluation for patients with traumatic brain injury (TBI) is to minimize secondary brain injury. Patients with TBI may require surgery for other associated injuries (eg, orthopedic, abdominal, or thoracic procedures). Even if such procedures are delayed beyond the immediate postinjury period, the goals for anesthesia should include prevention of secondary brain injury.

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Literature review current through: Nov 2017. | This topic last updated: Jun 12, 2017.
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