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Anesthesia in Head Injuries (Anestesia pada Trauma Kepala)

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Head injuries often pose problems for anesthesia, the main issues are cranial blood supplay, intracranial pressure, hypoxemia and shock. In severe head injuries, the autoregulation of the brain is often lost, causing the existing ischemic areas to suffer from inadequate blood supply, ensued by extending ischemic areas. Furthermore, intracranial pressure may increase due to intracranial causes. The choise of anesthesia is limited to substances that do not increase the blood supply to the brain, of increase intracranial pressure, or reduce the blood pressure. Anesthetic inhalation substances cause increased blood supply, but otherwise reduces oxygen metabolism. The most important preanesthetic measure is to immediately stabilize the general condition starting from the emergency room, where the role of the anesthesiologist is vital. Premedication is not always needed, while the most subtle methode of induction must be used, taking care to avoid couging or straining. Provision of intravenous fluids must be devised to maintain normal ostomotic pressure. Reduced osmotic pressure may cause reduction of the blood pressure, while increased osmatic pressure may lead to increased intracranial pressure. The management of other complications such as cardiovascular disorders, intracranial hypertension, hypoxia, diabetes insipidus, neurogenic pulmonary edema, and air or fat embolism must also be achieved. Postoperative case is best undertaken in the intensive care unit.

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Majalah Kedokteran Indonesia,45(3)1995:169-177

Publisher

: ., 1995

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Subject(s)

anesthesia
HEAD INJURIES

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