Anesthetic approach in pediatric brain injury
Traumatic brain injury (TBI) is defined as an insult to the brain resulting from external force, leading alteration in brain function, permanent or temporary impaired cognition, wide-spread impairments in motor and behavior function. TBI is not only a leading cause of death but it is a significant contributor to disability in pediatric age group. Its sequelae is an important health problem throughout the world. The patients face numerous difficulties to return to a productive life. Improvements in the prognosis continue with its elucidated pathophysiology, technological developments in its monitorization, and sustained scientific research. In 2003, the Society of Critical Care Medicine published the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolecents and updated the guidelines in 2012 with some significant changes. Pediatric anesthesiologists are frequently faced with the perioperative management of such patients. This article reviews pathophysiology, anesthetic management, hemodynamic support, management of intracranial hypertension of pediatric patients with TBI in the light of current evidence-based medicine. Informing the anesthetists confronting TBI patients in the intensive care unit, during preoperative and peri-operative periods, about important issues related to pathophysiology and treatment of TBI will contribute to the improvements in the prognosis of these patients.
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