Sedation as a method of neuroprotection in patients with traumatic brain injury in the intensive care unit: current evidence and perspectives (a literature review)

Kozin A. I.
Scientific department of Russian armed forces¹
ORCID iD: 0009-0004-1845-3865

1Federal State Budgetary Military Educational Institution of Higher Education «S. M. Kirov Military Medical Academy», Saint Petersburg, Russia

Kozin Alexander Igorevich; e-mail: virko-viktor@mail.ru

The study had no sponsorship.

The authors declare no conflict of interest.

03.04.2026

11.05.2026

Severe traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. The key pathogenetic mechanism is secondary brain injury driven by excitotoxicity, neuroinflammation, oxidative stress, and neuronal apoptosis. Sedative therapy in neurocritical care has traditionally been used to control intracranial pressure and synchronize with the ventilator, but current evidence indicates its potential as an active neuroprotective intervention. Objective. To analyze current understanding of the molecular mechanisms of neuroprotection achieved with sedative and anesthetic agents in patients with severe TBI, evaluate the clinical efficacy of various sedation strategies, and identify promising directions for the development of this method. A review of Russian and international literature from 2012 to 2026 was conducted using PubMed, Scopus, eLibrary, and Cochrane Library databases. Systematic reviews, meta-analyses, clinical guidelines were included, randomized controlled trials, experimental studies on neuroprotective effects of sedative drugs. Results. Sedative agents exert neuroprotective effects by modulating key components of secondary injury: inhibition of NMDA receptors (xenon, ketamine), activation of PI3K/Akt/mTOR and Nrf2 signaling pathways (sevoflurane, xenon), and suppression of NLRP3 inflammasome and neuroinflammation (dexmedetomidine, sevoflurane). Clinical studies have demonstrated that propofol and sevoflurane effectively reduce intracranial pressure, while dexmedetomidine and xenon improve cerebral oxygenation and neurological outcomes. Promising directions include inhaled sedation (sevoflurane, xenon, argon), the use of new drugs (ciprofol, remimazolam), and combined strategies. Conclusions. Sedative therapy in TBI extends beyond symptomatic control, becoming an active neuroprotective intervention. An optimal strategy requires a personalized approach that considers the pharmacological properties of the drugs, the specific features of the injury course and individual patient factors. 

traumatic brain injury, neuroprotection, sedation, intracranial pressure, neuroinflammation, intravenous anesthetics, inhalation anesthetics

10.29234/2308-9113-2026-14-2-120-145

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