Anesthesia for neurosurgical emergencies: Central nervous system trauma

Most neurosurgical emergencies that involve an anesthesiologist are caused by central nervous system trauma. The first priority is preservation of neural function by avoidance of complications (eg, hypoxia, hypercapnia, and cardiovascular instability). All anesthetic agents and techniques, including fluid resuscitation, alter intracranial dynamics. Choices appropriate to the pathophysiologic state will help to improve outcome. This article reviews the anesthesiologist's involvement in several critical steps, including initial resuscitation, intraoperative management, and postoperative care.