Anaesthesia of the head trauma patient

When head trauma cases are considered in veterinary medicine there is a tendency to think of the trauma cases such as a dog kicked in the head by a horse or a cat that has fallen from a high rise building that may potentially be referred elsewhere. It is however important to remember major trauma cases with potential traumatic brain injury (TBI) are seen routinely within general practices in the form of the many cats and dogs that get hit by motor vehicles. Careful consideration of the neurological state of these poly-trauma patients (Figures 1 and 2) should be made alongside cardio-vascular, respiratory and other assessments before considering and planning an anaesthetic.

There are many differing reasons for anaesthetising a head trauma patient and these include: diagnostic imaging; surgery; and in severe cases, to control ventilation. It is important for both veterinary surgeons and veterinary nurses alike to recognise the signs of head trauma and consequent TBI and understand the physiology of the ‘normal’ and injured brain to enable all concerned to formulate an appropriate anaesthetic plan and critically evaluate the potential adverse events and how these will be managed. The first consideration for the veterinary surgeon should be whether or not anaesthesia is necessary at the present time or whether it can wait for the patient to be stabilised. This could be either short-term or long-term stabilisation and may require delaying anaesthesia for a few minutes, hours or even days.