Traumatic brain-injured patients in the operative theatre

The perioperative management of a multiple trauma patient with brain injury is based, first of all, on the diagnosis of lesions requiring urgent treatment and the prioritisation of their management. This management must consider the type of extra-cranial lesions, the consequences of a potential surgery and the presence of intracranial hypertension. The priority of the intraoperative management is to limit secondary brain insults. This optimised management depends on the appropriate choice of anaesthetic agents, haemodynamic stabilisation with the treatment of haemorrhage shock and the correction of an associated coagulopathy, and the choice of a suitable monitoring for an individual optimisation of cerebral blood flow. Postoperative management will depend on the initial severity and brain compliance.