Preanesthetic evaluation

The perioperative management of a patient after traumatic brain injury (TBI) implies a rapid evaluation, the continuation of systemic and cerebral resuscitation, intensive monitoring, and an adequate anesthetic plan.

Airway Management

The choice of technique for tracheal intubation is determined by urgency, individual expertise, and available resources, and generally incorporates rapid sequence intubation with cricoid pressure and manual in-line stabilization.

Hemodynamic Assessment. Blood Pressure Management

Perioperative hypotension should be treated promptly.

Intravenous Fluids and Vassopressors

The Brain Trauma Foundation (BTF) guidelines recommend treating hypotensive patients with isotonic fluids, with the option of hypertonic fluids for patients with a Glasgow Coma Scale (GCS) rating of < 8.

Blood Transfusion

A target hemoglobin of 7 to 9 g/dL is recommended.

Coagulopathy Management

When coagulopathy is present, rapid reversal should be a high priority in the perioperative period in order to avoid hemorrhage expansion leading to secondary injury.

Antiplatelet Agents

The administration of platelets in TBI patients who have been treated with antiplatelet agents is recommended.

Vitamin K Antagonist

The use of prothrombin complex concentrate has been shown to be superior to plasma in the rapid reversal of vitamin K antagonists.

New Oral Anticoagulants

For TBI patients with ICH or subarachnoid hemorrhage who were taking rivaroxaban or apixaban, factor prothrombin complex concentrate was a good option to potentially reduce hematoma expansion.