Perioperative management of the pediatric patient with traumatic brain injury

Authors

  • Tarun Bhalla,

    1.  Departments of Anesthesiology, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
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  • Elisabeth Dewhirst,

    1.  Departments of Anesthesiology, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
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  • Amod Sawardekar,

    1.  Departments of Anesthesiology, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
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  • Olamide Dairo,

    1.  Departments of Anesthesiology, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
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  • Joseph D. Tobias

    1.  Departments of Anesthesiology, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
    2.  Departments of Pediatrics, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
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  • Section Editor: Andrew Davidson

Tarun Bhalla, Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
Email: tarun.bhalla@nationwidechildrens.org

Summary

TBI and its sequelae remain a major healthcare issue throughout the world. With an improved understanding of the pathophysiology of TBI, refinements of monitoring technology, and ongoing research to determine optimal care, the prognosis of TBI continues to improve. In 2003, the Society of Critical Care Medicine published guidelines for the acute management of severe TBI in infants, children, and adolescents. As pediatric anesthesiologists are frequently involved in the perioperative management of such patients including their stabilization in the emergency department, familiarity with these guidelines is necessary to limit preventable secondary damage related to physiologic disturbances. This manuscript reviews the current evidence-based medicine regarding the care of pediatric patients with TBI as it relates to the perioperative care of such patients. The issues reviewed include those related to initial stabilization, airway management, intra-operative mechanical ventilation, hemodynamic support, administration of blood and blood products, positioning, and choice of anesthetic technique. The literature is reviewed regarding fluid management, glucose control, hyperosmolar therapy, therapeutic hypothermia, and corticosteroids. Whenever possible, management recommendations are provided.

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