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TBI Emergent Anesthetic Management

Secondary-injury prevention framework: oxygenation, ventilation, perfusion, normothermia, euglycemia, seizure control, and ICP control during emergent TBI care.

Acute TBI anesthetic care prevents secondary brain injury by securing oxygenation, ventilation, perfusion, normothermia, euglycemia, and ICP control, since hypotension and hypoxemia are the most consequential omissions on oral boards.

If you forget

Headline: Prevent secondary injury — oxygenation, ventilation, perfusion, temperature, glucose, seizure, ICP

Board trap

ICP rises from 18 to 28 mmHg during emergent craniotomy — show stepwise escalation: head position → deepen sedation/analgesia → normocapnia → hyperosmolar therapy (mannitol 0.25-1 g/kg or 3% NaCl 150-250 mL) → CSF drain → decompressive craniectomy.

Key numbers

ICP goal: <22 mmHg
CPP goal: 60-70 mmHg
PaCO2 goal: 35-40 mmHg (normocapnia)
SpO2 goal: ≥94%
SBP goal: ≥100-110 mmHg
Mannitol dose: 0.25-1 g/kg IV

Reviewed Sep 16, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: ACS TQP TBI Best Practices 2024 · SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020

Re-review cadence: 12 months from reviewed date.

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Card ID: tbi-emergent · Path: aba.neuro.traumatic-brain-injury.tbi-emergent