title: Perioperative management of the pediatric patient with traumatic brain injury.
abstract: TBI and its sequelae remain a major healthcare issue throughout the world. With an improved understanding of the pathophysiology of TBI, refinements of monitoring technology, and ongoing research to determine optimal care, the prognosis of TBI continues to improve. In 2003, the Society of Critical Care Medicine published guidelines for the acute management of severe TBI in infants, children, and adolescents. As pediatric anesthesiologists are frequently involved in the perioperative management of such patients including their stabilization in the emergency department, familiarity with these guidelines is necessary to limit preventable secondary damage related to physiologic disturbances. This manuscript reviews the current evidence-based medicine regarding the care of pediatric patients with TBI as it relates to the perioperative care of such patients. The issues reviewed include those related to initial stabilization, airway management, intra-operative mechanical ventilation, hemodynamic support, administration of blood and blood products, positioning, and choice of anesthetic technique. The literature is reviewed regarding fluid management, glucose control, hyperosmolar therapy, therapeutic hypothermia, and corticosteroids. Whenever possible, management recommendations are provided.
authors.affiliation: Departments of Anesthesiology, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA   tarun.bhalla@nationwidechildrens.org
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhalla
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dewhirst
authors.forename: Amod
authors.initials: A
authors.lastname: Sawardekar
authors.forename: Olamide
authors.initials: O
authors.lastname: Dairo
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058109:Airway Management; D000758:Anesthesia; D000777:Anesthetics; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D008991:Monitoring, Physiologic; D009994:Osmolar Concentration; D019990:Perioperative Care / Q000379:methods*; D012121:Respiration, Artificial; D012151:Resuscitation; D012640:Seizures / Q000517:prevention & control
chemical_list: D000305:Adrenal Cortex Hormones; D000777:Anesthetics; D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D001786:Blood Glucose