The Anaesthetist and the Early Management of Acute Head Injuries.

Brain hypoxia during the acute stage of a head injury may result from the injury itself, an inadequate airway, associated injuries and blood loss. The maintenance of a clear airway is a major responsibility of the anaesthetist and some of the difficulties involved are discussed. Artificial ventilation of the lungs will become necessary when other measures have failed to ensure proper carbon dioxide elimination and adequate oxygenation. Intermittent positive pressure ventilation, when properly performed, has no deleterious effects on the brain. The special requirements of anaesthesia for intracranial surgery are re-stated. The value of controlled ventilation and hyperventilation of the lungs as a technique in neuroanaesthesia is briefly reviewed. Reference is also made to the use of hypertonic solutions of urea and mannitol in head injuries and to the use of hypothermia in patients with brain-stem damage.