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Reduced functional residual capacity, obstructive sleep apnoea, and increased thoracoabdominal pressures impair oxygenation and elevate intracranial pressure. Cardiovascular comorbidities such as hypertension and arrhythmias further compromise cerebral perfusion. Altered pharmacokinetics in obesity demand weight-adjusted anaesthetic dosing to avoid over- or under-sedation. This narrative review highlights the need for a structured, evidence-based approach involving preoperative optimisation, advanced airway planning, lung-protective ventilation, and invasive haemodynamic monitoring to maintain cerebral perfusion pressure. Postoperative strategies should include cautious extubation, continuous positive airway pressure or high-flow nasal oxygen, multimodal analgesia, and close neurological monitoring. Dexmedetomidine offers neuroprotective advantages with minimal respiratory depression. Multidisciplinary collaboration among anaesthesia, neurosurgery, and intensive care teams is critical to minimising perioperative risks and improving outcomes in this high-risk population.<\/jats:p>","DOI":"10.1177\/17504589251388894","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T07:27:27Z","timestamp":1763710047000},"page":"418-423","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuroanaesthesia in traumatic brain injury with morbid obesity: Perioperative strategy"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5261-6565","authenticated-orcid":false,"given":"Albinus Yunus","family":"Cobis","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dewi Yulianti","family":"Bisri","sequence":"additional","affiliation":[{"name":"Dr Hasan Sadikin Central General Hospital Bandung, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwan Abdul","family":"Rachman","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/clinpract13010020"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.13389"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/EA9.0000000000000029"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2023-331562"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03040-z"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001378"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.17085\/apm.23017"},{"issue":"5","key":"e_1_3_2_9_1","first-page":"564","article-title":"The current role of dexmedetomidine as neuroprotective agent: an updated review","volume":"11","author":"Liaquat Z","year":"2021","unstructured":"Liaquat Z, Xu X, Zilundu PLM, et al 2021 The current role of dexmedetomidine as neuroprotective agent: an updated review Brain Sciences 11 (5) 564","journal-title":"Brain Sciences"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-022-01579-8"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.37275\/bsm.v7i12.903"},{"key":"e_1_3_2_12_1","first-page":"1256","article-title":"Carbon dioxide pathophysiology and targets following acute brain injury Intensive","volume":"51","author":"Taran S","year":"2025","unstructured":"Taran S, Sekhon M, Robba C 2025 Carbon dioxide pathophysiology and targets following acute brain injury Intensive Care Medicine 51 1256\u20131259","journal-title":"Care Medicine"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-024-01201-x"},{"key":"e_1_3_2_14_1","unstructured":"Whitten C 2016 Positioning the head for intubation\u2013The Airway Jedi [Internet] Available from: https:\/\/airwayjedi.com\/2016\/04\/01\/position-head-intubation [Accessed May 2025]"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000988"}],"container-title":["Journal of Perioperative Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589251388894","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17504589251388894","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589251388894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:47:19Z","timestamp":1781790439000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17504589251388894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":14,"journal-issue":{"issue":"7-8","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/17504589251388894"],"URL":"https:\/\/doi.org\/10.1177\/17504589251388894","relation":{},"ISSN":["1750-4589","2515-7949"],"issn-type":[{"value":"1750-4589","type":"print"},{"value":"2515-7949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]}}}