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Paul Tenenbein, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington,
M. Sean Kincaid, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington,
Arthur M. Lam, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
Review the pathophysiology of traumatic brain injury.
Summarize the systemic manifestations of acute traumatic brain injury.
Review the current guidelines regarding management of traumatic brain injury.
Discuss the anesthetic management of traumatic brain injury and the potential complications.
Traumatic brain injury (TBI) imposes a significant burden on society, the presence of which is the primary determinant in quality of outcome following trauma . With respect to age, it occurs in a bimodal fashion. Young persons between 15 and 24 years suffer head injuries in motor vehicles and violence, especially in association with alcohol use. Older persons, particularly those older than 75 years, suffer from an increased frequency of falls leading to head injury. It is estimated that 1.6 million head injuries occur annually in the United States with 250,000 patients requiring hospitalization [2, 3]. The results of these injuries include 60,000 deaths and 70,000–90,000 permanent neurologic disabilities [2, 4]. It is estimated that $100 billion is spent annually in the United States alone providing care for these individuals. Primary prevention is essential to decrease the burden of this problem. But for those who do sustain TBI, there is much we can do to provide the best possible care for these patients. Although the Brain Trauma Foundation has provided guidelines for the management of severe traumatic brain injury (www.braintrauma.org), there are still many institutional differences in the care these patients receive, potentially affecting outcome .
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