Extradural Anesthesia in a Case of Mild Head Injury

We experienced a case posted for bilateral lower limb surgery in a patient having mild traumatic brain injury (TBI), where administration of graded epidural anesthesia led to agitation, probably resulting from the transient elevation of intracranial pressure (ICP). Due to the wide range of benefits provided by regional anesthesia, an anesthetist should be aware of the possible options for perioperative management to best handle such polytrauma cases. In this case, agitation was managed with a bolus of benzodiazepine and maintenance infusion of dexmedetomidine while the six-hour-long surgery continued with epidural anesthesia. This patient was a smoker who had bronchospasm and underlying pneumonia precluding a high risk for postoperative ventilatory support if only general anesthesia was administered. Post-surgery the patient was conscious, oriented, and pain-free leading to early mobilization and discharge from the hospital. The patient did not report any neurological deterioration in a follow-up period of one month.