Khandelwal Ankur, Bithal Parmod Kumar, Rath Girija Prasad
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesia and OR Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
J Anaesthesiol Clin Pharmacol. 2019 Jul-Sep;35(3):302-311. doi: 10.4103/joacp.JOACP_278_18.
Patients with severe traumatic brain injury often presents with extracranial injuries, which may contribute to fatal outcome. Anesthetic management of such polytrauma patients is extremely challenging that includes prioritizing the organ system to be dealt first, reducing on-going injury, and preventing secondary injuries. Neuroprotective and neurorescue measures should be instituted simultaneously during extracranial surgeries. Selection of anesthetic drugs that minimally interferes with cerebral dynamics, maintenance of hemodynamics and cerebral perfusion pressure, optimal utilization of multimodal monitoring techniques, and aggressive rehabilitation approach are the key factors for improving overall patient outcome.
重度创伤性脑损伤患者常伴有颅外损伤，这可能导致致命后果。此类多发伤患者的麻醉管理极具挑战性，包括确定优先处理的器官系统、减少持续损伤以及预防继发性损伤。在颅外手术期间应同时采取神经保护和神经挽救措施。选择对脑动力学干扰最小的麻醉药物、维持血流动力学和脑灌注压、优化使用多模式监测技术以及积极的康复方法是改善患者总体预后的关键因素。
