Anesthetic Management of Penetrating Nail Injury Brain: A Case Report

Abstract

Penetrating injury brain is common after accidental falls, sharp projectile injury, suicidal attempts etc. We present an unusual case of accidental penetrating nail injury brain in a 19 year old male patient presenting for emergency craniotomy. This case report highlights the difficulties faced in the anesthetic management of patients presenting with penetrating injury brain.

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

“…Given the aforementioned mortality rates, TBI is an emergency that requires prompt preoperative management and surgical intervention like similar surgical emergencies [17]. Following a penetrating TBI, adequate pre-hospital care geared at patient stabilization and securing the penetrated object to prevent further brain injury is crucial [9]. An assessment of the presence of a neurological deficit is important before any surgical intervention to remove the penetrating object Open Journal of Anesthesiology [5].…”

“…Here, prevention and correction of hypotension, hyper-or-hypoglycemia, hypo-or-hyperthermia, hypoxia, hypercapnia during mechanical ventilation are the main objectives during the perioperative management of penetrating TBI, geared at preventing secondary brain injuries [21]. Hence, perioperatively, both invasive and non-invasive blood pressure, pulse oximetry, capnography, urine output, arterial blood gas analysis, blood glucose, temperature, and electrocardiogram monitoring are important [9]. Thirdly, airway control often poses a considerable problem in patients with TBI as the pickaxe or any other foreign object may be oriented in a way which obstructs endotracheal intubation, and the ax only needs to be cut to gain access to the airways [22].…”

“…Also, anesthesia poses the problem of the choice of the type of technique of anesthesia which is general anesthesia with orotracheal intubation as the mainstay technique. Adequate intraoperative and postoperative analgesia is essential, as any noxious stimuli may cause a sympathetic surge increasing cerebral blood flow, cerebral oxygen consumption, and ICP [9]. All volatile hypnotics at MAC below 1, usually reduces cerebral oxygen consumption and lead to cerebral vasodilation with resultant increase cerebral blood flow which furthers increases ICP [9].…”

“…Adequate intraoperative and postoperative analgesia is essential, as any noxious stimuli may cause a sympathetic surge increasing cerebral blood flow, cerebral oxygen consumption, and ICP [9]. All volatile hypnotics at MAC below 1, usually reduces cerebral oxygen consumption and lead to cerebral vasodilation with resultant increase cerebral blood flow which furthers increases ICP [9]. In this regards, sevoflurane below 1 MAC is best suited for neurosurgical interventions [9].…”

Anaesthetic Management of Penetrating Brain Injury Caused by a Foreign Body

“…during their extraction. 6 Goals of anaesthesia are optimization of cerebral perfusion pressure (CPP) and prevention of intracranial hypertension; adequate anaesthesia and analgesia; prevention of secondary insults by adequate oxygenation, normocapnia, and avoidance of hyper or hypoglycaemia and hyperthermia. Anaesthesia and analgesia are essential, as surgical stimuli can increase cerebral blood flow (CBF), CMRO2, and ICP.…”