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An Italian survey of severe head trauma management during extracranial surgery

Published online by Cambridge University Press:  19 April 2005

N. Latronico ,
A. Chieregato ,
F. Rasulo ,
S. Piva ,
E. Zei ,
F. Procaccio ,
M. Gemma ,
L. Beretta  and
L. Targa
N. Latronico
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
A. Chieregato
Affiliation:
Servizio di Anestesia e Rianimazione, Ospedale Maurizio Bufalini, Cesena, FO, Italy
F. Rasulo
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
S. Piva
Affiliation:
Università degli Studi di Brescia, Istituto di Anestesia e Rianimazione, Spedali Civili, Milano, Italy
E. Zei
Affiliation:
U.O. di Neuroanestesia, Policlinico Le Scotte, Siena, Milano, Italy
F. Procaccio
Affiliation:
U.O. Anestesia e Rianimazione, Dipartimento di Neurochirurgia, Ospedale Maggiore, Verona, Italy
M. Gemma
Affiliation:
Servizio di Neurorianimazione, Ospedale San Raffaele, Milano, Italy
L. Beretta
Affiliation:
Servizio di Neurorianimazione, Ospedale San Raffaele, Milano, Italy
L. Targa
Affiliation:
Servizio di Anestesia e Rianimazione, Ospedale Maurizio Bufalini, Cesena, FO, Italy
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Abstract

Summary

Background and objective: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic.

Methods: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products.

Results: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport.

Conclusions: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.

Keywords

HEAD INJURIES, closedBRAIN TRAUMA, acute, secondaryANAESTHESIAHEALTHCARE SURVEYINTRACRANIAL PRESSUREHAEMODYNAMIC PHENOMENA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 227 - 232
Copyright
2005 European Society of Anaesthesiology

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