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Objective: To describe the optimal anesthetic management of patients with brain injury, with emphasis on the support of oxygen delivery to the brain, and the effects of anesthetic agents on cerebral perfusion. Data sources: Clinical and experimental studies from both the human and veterinary neuroanesthesia literature. Summary: The management of patients following primary traumatic brain injury (TBI) significantly impacts outcome. Outcome can be improved by strategies that improve oxygen delivery to the brain and prevent cerebral ischemia. Anesthetic agents have widely variable effects on the blood supply to the brain and, therefore, choice of anesthetic agent can influence neurological outcome. Although in the past, anesthetic agents have been selected for their neuroprotective properties, it is increasingly being recognized that the support of cerebral perfusion during anesthesia contributes more significantly to a positive outcome for these patients. Support of cardiorespiratory function is, therefore, highly important when anesthetizing patients with TBI. Conclusion: Choice of anesthetic agent is determined by the extent of brain injury and intracranial pressure (ICP) elevation. Factors that should be considered when anesthetizing head trauma patients include the effects of anesthetic agents on the cardiac and respiratory systems, their effects on cerebral blood flow (CBF), ICP, and possible neuroprotective benefits offered by certain agents.

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