Guidelines for the management of severe traumatic brain injury. XI. Anesthetics, analgesics, and sedatives.

A variety of pharmacological agents have been advocated to treat pain and agitation in the traumatic brain injury (TBI) patient. It is felt beneficial to minimize painful or noxious stimuli as well as agitation as they may potentially contribute to elevations in ICP, raises in blood pressure, body temperature elevations and resistance to controlled ventilation. Until recently the primary concern over the utilization of these agents has been related to their tendency to obscure the neurologic exam, with a secondary concern over potential adverse hemodymanic effects. In the previous edition of these guidelines,2 little information was provided regarding analgesic and sedation utilization in severe TBI. It was noted that there have been relatively few outcome studies and therefore “decisions about . . . use . . . and the choice of agents are left to the practitioner to make based on individual circumstances.”