In this episode of the Trauma and Burn Anesthesia Series, we examine traumatic brain injury, the leading cause of trauma-related death in the U.S., affecting over a million people annually and leaving millions with long-term disability. We discuss the importance of the Glasgow Coma Scale, the types of primary injuries such as subdural, epidural, and intraparenchymal hematomas as well as diffuse axonal injury, and how these lead to increased intracranial pressure, herniation, and neurological decline. We explore secondary brain injury from hypotension, hypoxemia, hypercapnia, and hyperthermia, emphasizing the need to maintain adequate perfusion and oxygenation while balancing damage control resuscitation. Key management strategies include hyperosmolar therapy, ICP monitoring, CSF drainage, hyperventilation, mannitol use, steroids, seizure and infection prophylaxis, and cautious fluid therapy. We also cover practical intraoperative considerations, avoiding excessive anesthetics, carefully managing CSF drains, and adjusting ventilation, while highlighting the added complexity when TBI patients also present with massive hemorrhage.

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