October 1, 2023

The brain is the essential part of the body, and any injury to the brain can cause severe complications and even cause death. For example, a severe blow or bang to the head can cause damage to the skull and brain tissues. 

Severe damage to brain tissue may cause issues like loss of some body function, comatose, or death. In addition, traumatic brain injury (TBI) patients can face severe complications, so when these patients undergo any surgery, it may lead to secondary damage if proper precautions are not taken. 

Understanding head trauma and its effects on the brain
Head injuries range from minor to severe types of traumatic brain injuries. Minor traumatic brain injury can cause temporary impairment of brain function. This may cause issues like dizziness, headaches, fatigue, irritability, depression, and memory problems. Some severe brain injuries take longer for treatment and include concussion, skull fracture, inflammation of brain tissues, blood clots in the brain because of injury, internal brain bleeding, etc. 

Need for anesthesia for patients with head trauma
A severe traumatic brain injury can affect other internal organs, limbs, lungs, spinal cord, etc. Thus, the management of anesthesia for TBI patients is crucial. This process is complex and involves a multidisciplinary approach. The different cases in which the TBI patient needs anesthesia include diagnostic imaging, craniotomy, extracranial surgery, or intensive care management. 

Proper care needs to be taken because of the patient’s condition. There are chances of new or secondary injuries that may result from hypotension, hypoxemia, hyper or hypoglycemia, increased intracranial pressure, etc., that may affect adversely. 

Steps involved in preparing a surgery requiring anesthesia for TBI patients
For a patient with TBI, the surgery’s primary aim is to correct the issue while preventing secondary damage. Therefore, anesthesia during the procedure or surgery is critical and more care or proper management is necessary. 

  • Pre-anesthesia evaluation: This evaluation includes understanding the extent of injuries and the person’s stability based on respiration and hemodynamic condition. The details for conditions like comorbidities, intoxication, and previous treatments should be noted. The different evaluations include airway and ventilation assessment, history of allergies, coagulopathy, potential anemia, metabolic status, etc.

  • Management of anesthesia: The main aim of anesthesia management includes improving oxygenation, avoiding secondary injuries, brain perfusion pressure, etc. The induction and intubation technique for anesthesia helps in minimizing the chances of pulmonary aspiration in TBI patients. The other factors considered for anesthesia management include mechanical ventilation, hemodynamic resuscitation, fluid management, etc.

Importance of anaesthesiologists in traumatic brain injury (TBI)
The importance and the role played by the anesthesiologist in the treatment and care of traumatic brain injury patients include the following. 

  • Maintaining the cerebral perfusion pressure
  • Controlling the intracranial pressure
  • Providing adequate surgical conditions
  • Avoiding the secondary injuries caused because of hypoxia, hypotension, hyper or hypoglycemia, hyper or hypocarbia, etc. 
  • Providing adequate amnesia and analgesia

Side effects of anesthesia for traumatic brain injury (TBI)
Anesthesia is required for TBI patients under different conditions. It helps to keep the patient sedated and also reduces the pain sensation. The minor side effects observed after the use of anesthesia include headache, drowsiness, nausea, etc., that subsides some time after the effect of the anesthesia fades. Also, the side effects depend on the level of sedation caused by the anesthesia. The side effects also depend on the type of anesthesia used, like general, local, or regional. 

During the period of anesthesia, it is essential to monitor the blood flow to the brain. It is necessary to allow oxygen-rich blood to flow through the brain cells continuously to keep the cells alive. Reduced blood flow may increase brain damage and can cause irreversible damage to the brain. Therefore, proper intubation of the patient is essential to maintain the oxygen levels. Failure to maintain may lead to brain damage.

The treatment and recovery of traumatic brain injury patients are slow. This development of the patient depends on the severity of the patient’s condition. Therefore, different therapies are included to improve the patient’s condition. Anesthesiologists play an essential role in the care of these TBI patients. They help in different situations like neurosurgery, resuscitation, stabilization, sedation during diagnostic imaging, craniotomy, intensive care management, and extracranial surgery.