Anesthetic Care for the Post-concussive Patient: There Are More Questions Than Answers
Purpose of Review
This review informs the practicing clinician regarding the pathophysiology of mild traumatic brain injury and its implication on the anesthetic management of patients presenting for surgery. It highlights several areas where data is sparse that might spark the interest of researchers. It proposes a broad guideline for managing patients who present for surgery.
The post-concussive brain has a vulnerable window of risk in which secondary insult might worsen long-term outcome. Scheduling elective surgery beyond this window of vulnerability might be beneficial. Several biomarkers may prove to be helpful in determining the timing of elective surgery and in risk stratification for the patient undergoing urgent or emergent surgery.
Mild traumatic brain injury is common. Patients often present in the acute care setting for surgical procedures unrelated to their head injury. The care of these patients may influence the natural history of their intracranial pathology and may impact long-term outcomes. In this review, we provide a brief synopsis of the pathophysiology of this disease. We discuss potential anesthetic interactions, offer broad guidelines for anesthetic management based on available data, and suggest areas of future research.
KeywordsMild traumatic brain injury Concussion Sports-related concussion (SRC) Concussive brain injury Anesthetic management Second impact syndrome (SIS) Post-concussion syndrome (PCS)
Compliance with Ethical Standards
Conflict of Interest
Paul Audu, Vanessa Oforiwa Aboagye, and Keyur Trivedi declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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