Carotid blowout syndrome (CBS) is a life-threatening emergency involving the rupture of the carotid arteries and/or branches, often following surgery and radiotherapy for head and neck cancer. Our case series aimed to describe airway management strategies, endovascular and surgical approaches, perioperative resuscitation management, and clinical outcomes in a cohort of patients with CBS at a tertiary referral academic health center. We retrospectively identified patients presenting with CBS between 2017 and 2021. Airway management, procedural treatment techniques, perioperative management, and clinical outcomes were extracted from the chart for each CBS occurrence. We identified 76 total cases among 62 patients (n=20 [26.3%] female; median age: 61.5 [IQR: 56 to 67]). Three cases were type I (threatened), 18 were type II (impending), 53 were type III (active bleed), and 2 were undeterminable. The most common airway management strategies were a pre-existing airway (n=37 [48.7%]), oral awake bronchoscopic intubation (n=14 [18.4%] occurrences), or nasal awake bronchoscopic intubation (n=8 [10.5%] occurrences). Resuscitation per case included intravenous crystalloid (mean: 1484mL, SD: 791mL), red blood cells (mean: 272mL, SD: 906mL), fresh frozen plasma (mean: 49mL, SD: 400mL), and platelets (mean: 11mL, SD: 94mL). Perioperative mortality was 16.1%. Thirty-nine patients (62.9%) died by the time of review (median: 157mo, IQR: 92 to 205mo). Perioperative management of CBS is challenging, particularly airway management, in which awake bronchoscopic intubation was common. Endovascular interventions were commonly performed. The investigation highlights the importance of advanced airway management strategies for patients with CBS.

Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes.

The perioperative management in adult cardiac surgery patients remains highly variable across centres and regions. The APECx study (Anaesthesia, Perfusion and surgical practicEs in Cardiac surgery) aims to describe the incidence of key clinical patient outcomes, map global variation in anaesthesia, perfusion and surgical practices in cardiac surgery, identify potential modifiable factors associated with relevant clinical outcomes, and explore global, socioeconomic and sex-based differences within these practices. APECx is a prospective multicentre observational study scheduled to start in 2026 that will be conducted in cardiac surgery centres worldwide. Through a modular design, the research focus will evolve over time by going through multiple study phases during a 10-year period. Participating centres can join or leave each study phase and will be actively recruited over the course of the entire study period. Data collection will occur biannually, including all consecutive eligible cases during two prospectively pre-specified locally defined consecutive weeks within a 3-month window. Data will be collected using a web-based electronic case report form. Collected data will be limited to a clearly delineated minimised dataset. All data are routinely obtained as part of standard clinical care. Overall clinical outcomes include, but are not limited to, intensive care unit (ICU) and hospital length of stay, and in-hospital mortality with a maximum follow-up of 30 days. A pilot study will evaluate the feasibility and quantify the workload for participating sites. This study protocol was approved by the Medical Ethics Review Committee of Amsterdam UMC and will be conducted in accordance with local regulations at each participating centre. APECx is a modular, multiphase, large-scale, international, multicentre cohort study with the potential to contribute to standardised, evidence-based care worldwide. By minimising site burden, APECx will allow centres with varying amounts of resources from various economies to join. The modular design uniquely positions it to provide a broad overview of global perioperative practices in cardiac surgery, while enabling detailed investigation of specific evidence gaps.

Current status of powered intracapsular tonsillectomy and adenoidectomy: A minimally invasive paradigm for pediatric obstructive sleep apnea surgery.

The NEonate and Children audiT of Anesthesia pRactice IN Europe (NECTARINE) study, led by the ESAIC Clinical Trials Network, collected prospective data on 5609 children up to 60 weeks postmenstrual age undergoing 6542 anesthetic procedures across 165 centers in 31 European countries (ESAIC_CTN_NECTARINE). While the study provides comprehensive European data, healthcare systems, perioperative practices, and organizational standards vary considerably between countries. Germany was selected a priori for a dedicated subcohort analysis due to its substantial contribution (10.3% of the total dataset) and notable differences to other European countries in the absence of a centralization and national training program in pediatric anesthesia. This focused evaluation aimed to benchmark national data against European findings, identify country-specific strengths and weaknesses, and support targeted quality improvement and guideline development within the German healthcare system. To compare the incidence, nature, and consequences of perioperative critical events between the German and non-German NECTARINE cohorts and to assess practice-related risk factors and outcomes. Data from 14 German centers were analyzed using mixed-effects logistic regression to examine associations between critical events and 30-day morbidity and mortality. Perioperative management practices and risk profiles were compared with those from the rest of the European cohort. The German cohort showed a significantly higher rate of critical events (47.0% vs. 33.9%, p < 0.001), with cardiovascular instability being most frequent (82.6%). Within German centers, the occurrence of a critical event nearly tripled the risk of postoperative complications within 30 days (OR: 2.85; 95% CI: 1.67-4.87). ASA status and number of surgeries were also significant predictors of morbidity. This prospectively defined subanalysis demonstrates that perioperative outcomes and practice patterns in Germany differ from European averages, particularly regarding the frequency of critical events, thresholds for intervention, staffing ratios, and complication profiles. These insights highlight the need for targeted interventions in German pediatric anesthesia, contribute to contextualizing European data, and offer baseline data for future cross-border quality initiatives and trials. ClinicalTrails.gov NCT02350348.

Targeting leukocytes, neutrophil extracellular traps and cytokines: A conceptual review to prevent primary graft dysfunction after lung transplantation.

Femoral neck fractures (FNF) in older adults are frequently managed with either total hip arthroplasty (THA) or hemiarthroplasty (HA). Despite improvements in surgical techniques, mortality rates after hip fracture surgery remain high. Identifying predictors of early mortality may enhance surgical decision-making, optimize perioperative management, and improve patient outcomes. The purpose of this study was to determine the short- and mid-term mortality rates after THA and HA for FNF, to identify clinical, demographic, and laboratory factors associated with 30-, 90-, and 180-day mortality, and to establish clinically relevant cutoff thresholds for significant continuous variables to stratify risk. We retrospectively reviewed 2379 consecutive patients treated for sub-capital FNF at a tertiary trauma center between [insert study years]. Of these, 831 underwent THA and 1548 underwent HA. Mortality was assessed at 30, 90, and 180 days postoperatively. Demographic, clinical, and laboratory parameters were analyzed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff thresholds for significant continuous predictors. Among THA patients, mortality was 1.4% at 30 days, 3.4% at 90 days, and 5.1% at 180 days. Postoperative albumin ≤2.85g/dL predicted 30-day mortality, while C-reactive protein (CRP)>19.15mg/dL was independently associated with mortality at 90 and 180 days. Among HA patients, mortality was 6.6% at 30 days, 12.9% at 90 days, and 17.6% at 180 days. Predictors of 30-day mortality included white blood cell count (WBC)>14.48×109/L, albumin <3.55g/dL, and Charlson Comorbidity Index (CCI)>7.5. At 90 and 180 days, age >83.65 and>89.34 years, WBC >13.49×109/L, albumin <3.35-3.45g/dL, creatinine >1.08mg/dL, and CCI >6.5 were associated with higher mortality risk. This study identified several laboratory and clinical markers that predict short- and mid-term mortality following hip arthroplasty for FNF. Hypoalbuminemia, elevated inflammatory markers, renal dysfunction, and high comorbidity burden were consistent risk factors. Incorporating these parameters into preoperative assessment may improve patient selection, perioperative optimization, and shared decision-making. III.

Iron Deficiency Anaemia (IDA) is the world’s leading nutritional disorder. While the conventional cardiovascular response to anaemia involves tachycardia due to sympathetic stimulation, anaemia-related autonomic dysfunction may paradoxically present as bradycardia. Such an atypical presentation can complicate perioperative management, particularly in patients scheduled for major surgery. Hereby, the authors present a case of a 54-year-old postmenopausal woman with an ovarian tumour and symptomatic IDA who exhibited autonomic dysfunction manifesting as sinus bradycardia. Her haemoglobin level was 4.7 g/dL, with markedly low ferritin levels consistent with chronic iron deficiency. She was transfused with three units of packed red blood cells, after which her haemoglobin improved to 11.2 g/dL. Combined epidural–general anaesthesia was administered for tumour resection. Intraoperatively, episodes of bradycardia and hypotension occurred but were successfully managed with intravenous glycopyrrolate and fluid boluses. The postoperative course was uneventful, with no recurrence of bradycardia. The present case highlights the importance of recognising anaemia-induced autonomic dysfunction as a potential perioperative complication. Careful anaesthetic planning, preoperative optimisation, vigilant haemodynamic monitoring, and timely intervention can result in favourable outcomes in such challenging situations.

Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited. Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses. A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates. Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

Ankle fractures are common, and cryotherapy is routinely used to reduce pain, swelling and local skin complications, both before and after surgery. The aim of this study is to report the results with the use of pre-operative third-generation cryotherapy (Z-One®, Zamar, Italy) in the management of patients with ankle fractures. We investigated the time to surgery, pain, opioid intake, and local skin complications. 169 patients with ankle fracture were randomised into two groups, the cryotherapy group (89 patients) and the control group (C: 80 patients). The time-to-surgery, Visual Analogue Scale (VAS) and the analgesic drug demands (Morphine Sulfate 10mg/ml solution for injection) were recorded. The development of skin complications was assessed on a daily basis. BMI and the number of cigarettes smoked were also recorded. The mean time-to-surgery was shorter in patients treated with cryotherapy compared to the control group (34.78h vs. 91.44h, p < 0.001). Significant differences between treatments and controls were found for VAS, morphine intake (number of vials), and skin complications. The mean preoperatory VAS and morphine consumption were lower in the cryotherapy group compared to controls (mean VAS 2.04 vs. 5.9, mean morphine consumption 0.1mg vs. 0.83mg). In the cryotherapy group, 4.5% of patients developed a skin complication compared to 28.7% of the control group; 85% of skin-related problems occurred in the non-cryotherapy group (p < 0.001). Preoperative third-generation cryotherapy is effective in reducing time to surgery, preoperative pain, and opioid intake in patients hospitalised for ankle fractures. It is also effective in reducing the occurrence of skin complications. No major complications related to the use of the device were reported. Third-generation cryotherapy is useful in the perioperative management of patients necessitating surgery for ankle fractures. Clinical Trial Registration NCT06396364. Level of evidence I (RCT).

Opioid Consumption and Fills after Surgery in Adults on High-Dose Prescription Opioids.

Robotic-assisted bronchoscopy (RAB) is an emerging diagnostic and interventional technology which integrates thin-slice CT-based virtual airway reconstruction, precise navigation, and stable robotic manipulation.It has been shown to offer clear advantages in the management of peripheral pulmonary lesions. With the rapid increase in clinical adoption in China, standardized guidance is required to ensure safe and effective use. Based on multidisciplinary expert discussions and a systematic review of the literature, this consensus summarizes key principles for the clinical application of RAB, encompassing technical foundations, indications and contraindications, procedural workflow, anesthesia and perioperative management, imaging integration, complication prevention, telemedicine application, and requirements for facilities and personnel training. The consensus emphasizes the importances of selecting appropriate patient, standardizing preprocedural planning and intraoperative navigation, optimizing anesthesia and ventilation to reduce CT-to-body divergence, and using multimodal imaging in a rational way to enhance lesion confirmation and procedural accuracy. In addition, it highlights the importance of structured emergency preparedness, device contingency management, and competency-based team training, while acknowledging current limitations and future development directions of RAB. These recommendations aim to support the safe, consistent, and evidence-informed integration of RAB into clinical practice, as well as to promote its standardized development in China.

Infants with ventricular septal defect (VSD) and concurrent respiratory compromise exhibit significant heterogeneity in their recovery after surgical repair. Objective tools for preoperative risk stratification are lacking. The primary aim of this study was to determine if preoperative hemodynamic data, acquired noninvasively using Electrical Cardiometry (EC), could predict prolonged mechanical ventilation (PMV) in infants undergoing VSD repair. We conducted a retrospective study of 51 infants. EC monitoring (ICON) was performed from admission to the day before surgery. A composite risk score was developed using Principal Component Analysis (PCA) of clinical characteristics and EC-derived hemodynamic parameters. The predictive performance of this score for PMV (defined as ≥ 12 h) was assessed using correlation and receiver operating characteristic (ROC) curve analysis. Leave-One-Out Cross-Validation (LOOCV) was used to assess the model's stability. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the change in the Index of Contractility (∆ICON) were identified as key parameters correlating with clinical classifications of cardiac dysfunction (r = 1.517 and 1.470, OR = 4.560 and 4.350 respectively, p < 0.05). A PCA-derived composite score was identified as a potential predictor of PMV with r = -0.522 in correlation (p < 0.001) and AUC = 0.856 (SE = 0.857, SP = 0.773, LOOCV AUC = 0.830), outperforming individual clinical variables alone. A composite risk score integrating individual data and EC hemodynamics monitoring can effectively identify infants at high risk for PMV following VSD repair. This approach may provide a valuable tool for perioperative management and resource allocation.

Acute pulmonary thromboembolism (PTE) is a clinical emergency caused by thrombus obstruction of the pulmonary artery. The mortality rate of high-risk PTE patients without timely intervention is as high as 10%-30%, while standardized interventional therapy can significantly reduce the mortality rate to about 3%. Although interventional therapy has been widely used in the treatment of PTE patients, there is currently a lack of standardized operating procedures for this technique, and there are significant differences among different medical institutions and operators. In order to further improve the level of interventional therapy for PTE in China and promote the standardization of interventional therapy for PTE, the Pulmonary Embolism and Pulmonary Vascular Disease Group of the Respiratory Diseases Branch of the Chinese Medical Association and the Pulmonary Embolism and Pulmonary Vascular Disease Working Group of the Respiratory Physicians Branch of the Chinese Medical Doctor Association jointly organized experts in related fields in China. Based on the latest evidence-based medical evidence and combined with China's clinical practice, they focused on the patient selection, operating procedures, and peri-operative management strategies for interventional therapy of acute PTE. After multiple rounds of discussion, they jointly formulated the "Expert Consensus on Operating Procedures for Interventional Therapy of Acute Pulmonary Thromboembolism".Recommendation 1: Interventional therapy for acute PTE should be based on risk stratification. Intermediate-risk and high-risk patients may be considered for interventional therapy under the decision-making of multidisciplinary discussion.Recommendation 2: Interventional therapy has unique advantages in the treatment of acute PTE patients, but local technical conditions should be considered, including factors such as the availability of medical devices and the experience of operators.Recommendation 3: For trans-catheter thrombus removal in acute PTE, dedicated devices are recommended to improve efficiency and safety.Recommendation 4: Interventional therapy is recommended in the following situations: high-risk acute PTE with contraindications to or failure of thrombolytic therapy; intermediate-high-risk acute PTE with contraindications to or failure of thrombolytic therapy; and intermediate-high-risk acute PTE with hemodynamic deterioration during anticoagulant therapy.Recommendation 5: The multidisciplinary teams required for interventional therapy of acute PTE include the Department of Respiratory and Critical Care Medicine, Intensive Care Unit (ICU), Department of Cardiovascular Medicine and Surgery, Department of Thoracic Surgery, Department of Radiological Interventions, etc.Recommendation 6: Pulmonary angiography should be performed before interventional therapy to clarify the location and degree of pulmonary thromboembolism, guide interventional therapy, and improve efficiency.Recommendation 7: During the operation, blood loss should be minimized, vital signs such as blood pressure and heart rate should be monitored in real time, and the patient's vital signs and subjective feelings should be paid attention to avoid serious complications such as hemorrhagic shock (It is recommended to control blood loss below 200-300 ml).Recommendation 8: The goals of interventional therapy for acute PTE are to improve oxygenation and hemodynamics, such as decreased heart rate, increased systemic blood pressure, reduction in vasoactive medications, and increased oxygen saturation, etc.Recommendation 9: Heparinization is recommended during the operation (unless strictly contraindicated), and anticoagulation should be continued after the operation.

People with mild haemophilia (PMH) may require surgical treatment. To analyse the literature related to surgery in PMH. An English-language literature search in PubMed (MEDLINE) for articles published between the start of the search engine until 2 March 2026 was carried out using "mild haemophilia surgery" as keywords. A total of 445 publications were encountered, of which only 64 were analysed because they were strictly connected to the title of this article (inclusion criterion). The remaining 381 were excluded because they were not strictly connected to the title of this article. It was found that PMH have undergone pseudotumour, urological and dental surgery, and a wide variety of other surgical procedures with satisfactory results. However, in comparison with severe and moderate haemophilia patients, PMH have a higher risk of postoperative bleeding, death, and redo surgery. Besides, dosing above factor (F) VIII target ranges with FVIII concentrates was frequent during peri-operative management of PMH. The Arg593Cys genotype and intense peri-operative utilization of FVIII, particularly when given by continuous infusion, have been connected to a high risk for inhibitor appearance in PMH A. To reduce the risk of developing inhibitors, treatment with desmopressin should be used whenever possible in PMH. In PMH with high-risk mutations who require major surgery, the combined use of desmopressin and FVIII concentrates should be considered.

The discipline of cardiac implantable electronic devices (CIED) has undergone numerous technical innovations in recent years. Leadless pacemaker systems are increasingly being implanted, biventricular cardiac resynchronization therapy (CRT) is firmly established and subcutaneous or extravascular implantable cardioverter defibrillators (S-ICD, EV-ICD) have become available. Moreover, advances such as direct stimulation of the cardiac conduction system with conduction system pacing systems and loop recorders with dimensions smaller than aUSB stick illustrate the remarkable pace of technological innovation. For anesthesiology personnel these innovations have particular clinical relevance. The rising prevalence of patients with CIED undergoing noncardiac surgery underscores the need for athorough understanding of device functionality, perioperative management strategies and potential interactions with anesthetic techniques. This article provides an overview of the most significant technological advances in the field of CIED and outlines practical recommendations to support the safe and effective integration into daily anesthesiological practice.

This review discusses the anesthetic management of patients with movement disorders, including those undergoing nonneurologic surgery, those undergoing deep brain stimulation surgery, and the perioperative care of individuals with deep brain stimulators. Safe anesthesia in patients with movement disorders aims to preserve baseline neurologic function and prevent perioperative worsening of symptoms. Key elements include identifying the specific movement disorder, understanding functional limitations and comorbidities, and managing chronic medications regardless of the surgical procedure. In deep brain stimulation surgery, anesthetic practice has evolved from predominantly "awake" techniques to a patient-centered approach that may involve awake surgery, monitored sedation, or general anesthesia. Technological advances such as high-resolution imaging, robotic assistance, and intraoperative computed tomography or MRI have improved targeting accuracy and expanded the feasibility and safety of asleep deep brain stimulation. Additionally, anesthesiologists increasingly care for patients with existing deep brain stimulation systems, which requires vigilance to prevent electromagnetic interference or electrical conduction that could impair device function or harm brain tissue near the electrodes. Anesthetic care for patients with movement disorders spans a broad clinical spectrum, from routine surgery to deep brain stimulation implantation and subsequent procedures in patients with implanted devices. Optimal outcomes depend on multidisciplinary collaboration, individualized anesthetic planning, and meticulous perioperative management to minimize neurologic and device-related complications.

Post-operative atrial fibrillation (POAF) prolongs recovery after cardiac surgery. We evaluated whether two myocardial-remodelling biomarkers-procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP)-predict POAF in elderly patients. In a prospective cohort (August 2024 - January 2025), 113 patients ≥ 65 years undergoing coronary artery bypass grafting, valve, or combined surgery were enrolled. Pre-operative serum PICP and PIIINP were quantified. POAF episodes were continuously monitored for five days. Independent predictors were identified with multivariable logistic regression, and discriminative performance was assessed using receiver-operating-characteristic (ROC) curves with 2,000-bootstrap internal validation. POAF developed in 40 patients (35.4%), peaking on post-operative day 2. Compared with non-POAF patients, the POAF group had larger left atria (45.3 ± 4.8 vs. 40.7 ± 5.1mm; p < 0.001) and higher PICP (128.4 ± 27.1 vs. 103.2 ± 24.6µg/L) and PIIINP (13.3 ± 3.9 vs. 9.8 ± 2.8µg/L) concentrations (both p < 0.001). Age, left-atrial dimension, PICP, and PIIINP remained independent predictors (all p < 0.05). A model combining both biomarkers achieved an area under the ROC curve (AUC) of 0.86, outperforming PICP (0.80) or PIIINP (0.78) alone. Bootstrap validation yielded a mean AUC of 0.85 (95% CI 0.79-0.90), indicating good internal robustness. Elevated pre-operative PICP and PIIINP independently predict POAF in elderly cardiac-surgery patients, and their combination enhances risk stratification beyond clinical factors. Incorporating these biomarkers could guide targeted prophylaxis and improve peri-operative management; prospective multicentre validation is warranted.

Perioperative patient blood management (PBM) is a crucial, multidisciplinary, evidence-based approach aimed at optimising patient outcomes by reducing unnecessary erythrocyte transfusions. This study assessed the knowledge and attitudes of healthcare professionals in two key surgical specialties toward PBM. This cross-sectional questionnaire-based survey involved personnel from the Department of Anaesthesiology and the Department of Orthopaedic Surgery at a university hospital. The questionnaire assessed knowledge (scored out of 100) and attitudes (specifically self-reported adherence, scored out of 100). The correct responses were based on the PBM guidelines and institutional protocols. Multivariable logistic regression was used to identify predictors of adherence. The overall response rate was 86.2% (n = 250) from 163 Anaesthesiology and 87 Orthopaedic Surgery. The Orthopaedic Surgery group scored significantly lower on knowledge assessments than the Anaesthesiology group (median score 48 vs. 58, p < 0.001). However, the attitude scores were statistically similar (median score 77 vs. 76, p = 0.237), revealing a knowledge-attitude paradox. Multivariable logistic regression identified hierarchical position as the only significant independent predictor: staff physicians were 7.1 times more likely to report adherence compared to residents (adjusted odds ratios 7.1, 95% confidence interval 3.1-16.2, p < 0.001). Individual knowledge level was not a significant predictor. Our study demonstrates that hierarchical mandate, not individual knowledge or department affiliation, is the primary driver of PBM adherence. Implementation efforts must therefore leverage staff physician leadership to mandate PBM as the institutional standard of care, ensuring that positive attitudes translate into consistent practice.

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols.