18 Sedation and Anesthesia

The patient with a severe acute head injury, often with other bone and soft-tissue injuries, presents a complex management problem involving a large number of medical and paramedical staff. A coordinated approach is essential, with clear and frequent communication between the involved personnel on all aspects of critical care, including initial resuscitation, anesthesia, radiological imaging, surgical intervention and intensive care management. The anesthetist is an active member of this team and is involved in many stages of management. Indeed, the anesthetist is often the one medical specialist in constant attendance from hospital admission through to the postoperative ward or intensive care unit. Furthermore, therapy instituted by the anesthetist, such as the choice of sedative agents, paralysis, intubation and fluid management, will directly impact upon other aspects of management, such as neurosurgical and intensive care treatment. The anesthetist must have a sound knowledge of cerebral pathophysiology and pharmacology and of the acute medical care of the multiply injured patient. Many of these aspects are covered in other sections of this book. The conduct of basic anesthetic techniques is well covered in general anesthetic texts. This chapter will therefore concentrate on the pharmacology of drugs in current use and aspects of anesthetic management specifically related to the patient with a severe head injury.