PERIOPERATIVE MANAGEMENT OF HEAD INJURY

Muh Ramli Ahmad
Department of Anesthesilogy Faculty of Medicine Hasanuddin University Makassar

SUMMARY
The incidences of head injury in the United State reached 500.000 cases yearly. Ten percents or them died before reach the hospital. Management of head injury has to be started on the spot of the accident (prehospital) in order to avoid secondary brain damage. The secondary brain damage might be caused either by systemic disorder or intracranial. The systemic disorders are hypoxemia, hypercapnia, hypotension, anemia, hypovolemia, hyponatremia, hyperthermia, sepsis, and coagulopathies. Intracranial factors are epidural/ subdural hematoma, cerebral contusion, intracerebral infection, and post-trauma epilepsy. Preoperative evaluations are included: Anamnesis the history of accident and the mechanism of injury, which can help to determine the prognosis. The vital signs have to be examine, hypotension could be caused by injury in others place. Hypertension especially accompanied by bradycardia showed elevated of intracranial pressure by mass lesion that needs surgical procedure. The principal management of head injury are optimize of cerebral perfusion, avoid secondary ischemia and administration of drugs/ techniques which can caused elevation of intracranial pressure. Premedication in head injury usually is unnecessary. However, if general anesthesia is the alternative for ideal induction require maneuver to avoid hypotension, elevation of both blood pressure or intracranial pressure. Penthotal is an ideal induction agent if there no contraindications where it can reduce the cerebral blood flow (CBF) and intracranial pressure (ICP); while if there any contraindication propofol is the choice. The maintenance of anesthesia used drugs, which less affected to the CBF, CBV, CMRO2 and auto regulation, usually using the combination of barbiturate, narcotic, N2O, volatile anesthetic with, low MAC and muscle relaxant.(J Med Nus. 2004; 25:50-54)