Brain injuries: Perianesthetic management

Traumatic brain injury and its treatment or better still prevention has concerned man for centuries. While many of the pathways that result in neuronal damage are recognized, means to prevent or decrease impairment are less well understood. Many scores and more recently biomarkers have been used successfully to prognosticate survival. Early control of raised intracranial pressure is essential as is also normalization of systemic blood pressure and prevention of hypoxia and hypocarbia. Fluid resuscitation should be carefully balanced against output and sugar-containing solutions should be avoided.