Anesthesia for Trauma Patients

Abstract

An improved understanding of the pathophysiology of combat trauma has evolved over the past decade and has helped guide the anesthetic care of the trauma patient requiring surgical intervention. Trauma anesthesia begins before patient arrival with warming of the operating room, preparation of anesthetic medications and routine anesthetic machine checks. Induction of anesthesia must account for potential hemodynamic instability and intubation must consider airway trauma. Maintenance of anesthesia is accomplished with anesthetic gas, intravenous infusions or a combination of both. Resuscitation must precede or be ongoing with the maintenance of anesthesia. Blood product transfusion, antibiotic administration, and use of pharmacologic adjuncts (e.g., tranexamic acid, calcium) all occur simultaneously. Ventilatory strategies to mitigate lung injury can be initiated in the operating room, and resuscitation must be effectively transitioned to the intensive care setting after the case. Good communication is vital to efficient patient movement along the continuum of care. The resuscitation that is undertaken before, during and after operative management must incorporate important changes in care of the trauma patient. This Clinical Practice Guideline hopes to provide a template for care of this patient population. It outlines a method of anesthesia that incorporates the induction and maintenance of anesthesia into an ongoing resuscitation during surgery for a trauma patient in extremis.

Anesthesiology for Trauma Medicine: Roles, Medications, Airway Management, and Multidisciplinary Team Coordination

“…The main goal of induction and maintenance is to maintain hemodynamic stability. If the patient is hemodynamically unstable, continue to resuscitate the patient preceding and during induction [57]. Adequate intravenous access is critical for timely resuscitation.…”

“…If invasive access is needed, do not hesitate to proceed. It is best to ask the trauma team to maintain the patient's arms in an abducted position so that invasive access can be easily obtained without further delaying the surgery [57]. Given the time constraints, if possible, preoxygenate the patient with four vital capacity breaths prior to intubation.…”

“…In certain scenarios, the patient may be obtunded. If so, proceed with apneic oxygenation [57]. When inducing, consideration should be given to the dose of the induction agent as trauma patients may require a much lower dose.…”

Anaesthetic considerations in polytrauma patients

“…1 An improved understanding of the pathophysiology of polytrauma has evolved over the past three decades including evolving models of trauma care which has helped guide the anaesthetic care of patients requiring surgical intervention. 2,3 The role of anaesthesia in polytrauma requires an integrated, team approach. The optimal management of patients of trauma requires a multi-disciplinary, multimodal, and coordinated team approach for a successful outcome.…”

Dynamics of Stress Laboratory Findings and Their Relation to Psychoemotional State During Regional Anesthesia in Patients With Lower Limbs Injuries

“…A large number of surgeries for lower limbs injuries are performed all over the world and in our country, therefore their adequate anesthetic support remains a critical task. A lot of works have been dedicated to the issue of choice of the anesthesia method during these surgeries, the advantages and disadvantages of both general and regional anesthesia are described [1,2]. In recent years, the methods of regional anesthesia are preferred due to their sufficient level of pain control as well as economic efficiency [3,4].…”