ANESTHETIC CONSIDERATIONS FOR PATIENTS WITH NEUROLOGICAL DISORDERS: A COMPREHENSIVE REVIEW OF CURRENT EVIDENCE

Abstract

Abstract

The co-occurrence of oral-maxillofacial injuries with neurological disorders presents significant perioperative challenges. This Meta-analysis aims to comprehensively summarize considerations and best practices essential for managing these complex cases. Key areas covered include balancing cerebral oxygen supply and demand, optimizing ventilation, maintaining hemodynamic stability, managing fluid and electrolyte balance, and employing strategies to enhance patient outcomes. A thorough literature review utilizing PubMed and Google Scholar databases was conducted to gather data from controlled trials, cohort studies, and meta-analyses pertaining to neurological disorders and oral and maxillofacial surgery (OMFS). Search terms included traumatic brain injury, facial trauma, airway management, pain management, prophylactic anticoagulation, and intracranial pressure. Articles were screened based on relevance to the research question, prioritizing those in English, and categorized into pertinent themes. A narrative synthesis was employed to ensure a balanced and comprehensive overview, incorporating guidelines from professional organizations. Key elements of secondary brain injury pathophysiology were identified, emphasizing strategies to mitigate delayed neurological deterioration. The management of trauma patients at risk for blunt cerebrovascular injuries was explored, detailing diagnostic approaches and management options. Airway management, hemodynamic considerations, and optimization of coagulation and cellular homeostasis were discussed within the context of perioperative care for neurological injury patients undergoing OMFS. Anesthetic options were highlighted, emphasizing the critical importance of maintaining hemodynamic stability and cerebral perfusion. Comprehensive perioperative and postoperative care strategies were underscored as essential for improving cerebral perfusion and cellular homeostasis, thereby optimizing outcomes for patients with neurological injuries requiring OMFS. This review serves as a practical guide for clinicians involved in the multidisciplinary care of these complex patients, integrating understanding of pathophysiology, potential complications, and evidence-based management strategies. Specialized perioperative management tailored to the unique needs of patients with neurological injuries undergoing OMFS is crucial. By advancing knowledge of pathophysiology and integrating best practices, clinicians can significantly enhance patient outcomes.