Anaes Cases · Neuroanaesthesia
The acutely herniating TBI — the crash induction
The hot case — the acutely herniating TBI. The rapid sequence with the haemodynamic preservation, the immediate ICP reduction (the head-up, the mannitol/hypertonic saline, the modest hyperventilation), the MAP 80 mmHg, and the surgical decompression.
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ANZCAFRCAABAEDAIC
Prompt
An unconscious trauma patient with the blown pupil and the Cushing response requires the immediate intubation and the OR. Manage the induction and the first 30 minutes.
Presentation
A 28-year-old man, unrestrained in the high-speed crash, arrives unconscious (the GCS of 6) with the right pupil dilated and unreactive (the blown pupil) and the Cushing response (the hypertension and the bradycardia). The CT shows the large right extradural haematoma with the midline shift. He needs the immediate intubation and the emergent craniotomy. Manage the induction and the first 30 minutes.
References2ShowHide
- [2]Blacker SN, et al. Intraoperative anesthetic care during emergent craniotomy for TBI. J Neurosurg Anesthesiol, 2026.PMID 39793097
- [39793098]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.