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PERIOPERATIVE MANAGEMENT OF PATIENTS WITH HEAD AND SPINAL CORD TRAUMA

      Central nervous system (CNS) trauma is a significant cause of morbidity and mortality in the United States. Each year, 500,000 patients with head injuries are seen in emergency departments (EDs), and, of these, more than 50,000 die from their injuries. There are 12,000 cases of severe spinal cord injury each year, with a mortality rate approaching 50%. Many patients who survive suffer permanent disability.
      Clearly, prevention of CNS injuries is the ideal solution. Anesthesiologists are often involved in the care of patients who present to hospitals, whether it be resuscitation in the ED or management of anesthesia in the operating room. Head-injured patients commonly require surgery for acute decompression of subdural hematomas, epidural hematomas, or intracerebral hemorrhages. Trauma patients with spinal cord injuries present acutely for decompression in the setting of neurologic deterioration, or for reduction and stabilization procedures when conservative measures do not achieve these objectives. In addition, patients with CNS trauma often undergo surgery unrelated to their neurologic injuries.
      This article provides an overview of the perioperative management of patients with CNS trauma.
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