Anesthetic Management of a Rare Penetrating Traumatic Brain Injury Caused by a Pickaxe: A Case Report

Abstract

Penetrating traumatic brain injuries (TBI) are frequent neurosurgical emergencies, associated with a high mortality rate and we almost no previous report on a penetrating pickaxe TBI. Herein, we report and discuss the anesthetic challenges encountered in the surgical extraction of a pickaxe from a patient with TBI. We present the case of a 34-year-old man who presented with a penetrating pickaxe TBI at his left temporal region, signs of raised intracranial pressure and normal vital signs. Anesthetic management began within 3 hours of admission and consisted of general anesthesia and rapid sequence intubation. Surgical extraction of a 14 cm long wing of the pickaxe was achieved with good hemostatic control. His postoperative course was marked by complete blindness of the right eye till one year of follow-up. The authors highlight the need of a prompt multidisciplinary management with close perioperative monitoring of haemostatic control and signs of raised intracranial pressure as key factors for a favourable postoperative outcome.

Anesthesia Management of a Patient with Penetrating Brain Injury with a Knife into the Occipital Region

“…The goals of anesthesia, that is, optimization of cerebral perfusion pressure (CPP) and prevention of secondary brain injury, were achieved. Anesthesia management was similar to that described by Parua et al, 2 Dalal and Vijayan, 3 Awori et al, 4 Khandelwal et al, 10 and Mbengono et al, 11 at par with the latest brain trauma foundation guidelines.…”