Give four principles of anaesthetic management for this patient?

The basic principles of managing a patient with a brain injury are to prevent secondary injury. This may be achieved by:

Maintain Cerebral Oxygenation
  • Maintain adequate cerebral blood flow:
    • Target CPP of 60 - 70 mmHg1
  • Maintain adequate oxygenation (pO2 >10 kPa) 1
  • Avoid anaemia 1
Reduce Cerebral Metabolic Demand
  • Treat seizures aggressively 1
  • Ensure adequate levels of sedation and analgesia 1
  • Avoid hyperthermia 1
Reduce Intracranial Volume / Pressure
  • Control PaC02 (4.5-5.0 kPa) 1
  • Prevent expansion of intracranial hematoma
    • Optimization of coagulation 1
  • Avoid venous congestion 1
    • Head in midline
    • Sit up to 30° degree angle
    • Use adhesive or loose ETT tapes / ties
  • Avoidance brain oedema:
    • Administration of isotonic solutions only 1
    • Aim sodium: 145-155 mmol/L