Perioperative Considerations in Patients With Concussion.

Area of Science:

• Neuroscience
• Anesthesiology
• Trauma Care

Background:

• Concussions disrupt autonomic nervous system function, glucose metabolism, and cerebral autoregulation.
• Anesthesia impacts these same physiological processes, necessitating careful perianesthesia management.
• No current practice guidelines exist for the perianesthesia care of concussed patients.

Purpose of the Study:

• To review the literature and answer key clinical questions regarding perianesthesia management of concussed patients.
• To identify best practices for preventing secondary neurologic injury in this population.
• To highlight areas where further research is needed.

Main Methods:

• Literature review including randomized controlled trials, systematic reviews, and integrative reviews.
• Evaluation of articles for clinical relevance to nurse anesthesia practice.
• Focused review to address specific clinical questions.

Main Results:

• Literature emphasizes preventing secondary neurologic injury.
• Maintaining optimal mean arterial pressure and Paco₂ is crucial to prevent global hypoperfusion.
• The specific effects of anesthetic agents on concussion injuries remain largely unknown.

Conclusions:

• Careful attention to hemodynamic parameters and ventilation is vital in the perianesthesia period for concussed patients.
• Further research is required to establish evidence-based interventions for anesthesia management post-concussion.
• Advances in neuroimaging and biomarkers offer future potential for improved patient care.