Anesthetic considerations and care management of children with traumatic brain injury

Abstract

Abstract Traumatic brain injury (TBI) in the pediatric population persists to be a global health burden contributing to significant morbidity and mortality. The in-hospital management of pediatric TBI differs from adult TBI due to the various inherent age-specific anatomical, physiological, and pathological differences. Their peri-operative care encompasses initial stabilization in the emergency room, sedation for diagnostic imaging, medical management in the intensive care unit, anesthesia for emergent decompressive craniotomies in the operating room, support of recovery from anesthesia in the postoperative suite, and postoperative management in the emergency trauma care unit until hospital discharge. Disturbed cerebral autoregulation and compromised intracranial compliance predispose to cerebral ischemia and edema. Refractory intracranial hypertension is observed to be the most important predictor of poor outcome and mortality in these patients. Multimodal neuromonitoring paves the way for a better contemplation of the underlying intracranial pressure, cerebral hemodynamics, cerebral oxygenation, and neuronal electrical activity. The peri-operative goals revolve around the maintenance of cerebral and systemic homeostasis, the key components of which are discussed here. This review also discusses the key recommendations and practice guidelines proposed by the Brain Trauma Foundation for the critical care management of pediatric patients with severe TBI. A thorough knowledge about pediatric neuroanatomy and neuropathophysiology of TBI in concordance with the multidisciplinary application of best management practices fosters the best possible neurocognitive outcome among pediatric TBI survivors.