Traumatic Brain Injury (TBI)

Prevent secondary injury - The governing principle: avoid hypoxia and hypotension absolutely (both worsen outcome), maintain cerebral perfusion pressure, and keep the brain oxygenated.

Airway with C-spine precautions - Assume a cervical-spine injury and a full stomach; secure the airway with in-line stabilization and a rapid-sequence induction, avoiding hypoxia and big pressure swings.

Control ICP and CO2 - Maintain normocarbia (hyperventilate only briefly as a temporizing measure for herniation), position head-up, avoid ICP-raising factors, and treat surges.

Hemodynamic targets - Maintain blood pressure to preserve cerebral perfusion pressure; treat hypotension aggressively — it's devastating in TBI.

Glucose and temperature - Avoid hyperglycemia and hyperthermia (both worsen brain injury) and avoid hypoglycemia.

Traumatic brain injury is mechanical injury to the brain. Beyond the primary injury, the anesthetist's job is preventing secondary injury — the cascade of hypoxia, hypotension, hypercarbia, raised intracranial pressure, and impaired perfusion that turns salvageable brain into infarct.

Severe TBI raises intracranial pressure and threatens cerebral perfusion pressure; associated injuries, a full stomach, and possible cervical-spine injury complicate the airway. The whole management is protecting the injured brain's oxygen and blood supply.