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In-Reply-To: <002701be35b5$ac4e06e0$1a79a8c2@default> There is unfortunately no work in this important group of patients. However, it is well-known that struggling puts up the venous pressure and that if you have areas of brain injury CBF autoregulation breaks down within those. The most important precept then is to do no further harm; this is the basis for immobilisation, oxygenation and ensuring that the patient is not hypotensive. Disregard the current furore about hypotensive resuscitation. If you can only achieve these aims with sedation, then that is fine. Indeed, we had a patient in the other day who had fallen down stairs and had sustained a minor head injury but was very irritable. He settled nicely with 5mg of midazolam - from the anaesthetist! I am not sure what her objection is or what it was based on. If you can find out what her concerns were, and then discuss those with your anaesthetic colleagues they are the ones who are most likely to be able to give you a locally useful answer. FWIW I would have been quite content. Best wishes, Rowley Cottingham [log in to unmask] Blah blah blah legal legal lawyers sue blah sue blah %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%