ANESTHESIA : Challenges and Anesthetic Management in Trauma: Airway and Hemodynamic Instability, and Multisystem Injury Considerations

ANESTHESIA FOR TRAUMA

Trauma patients often require emergency anesthesia under less-than-ideal circumstances, which demands special attention to their unique medical challenges.

Management of trauma patients poses unique challenges due to the following reasons:

Inadequate medical history:

 Attendant may not be present and patient may not be fit enough to give his/her medical history.

Most often patients undergoing emergency surgery are not fasting.

Patients may be intoxicated.

Multiple Injuries

Multiple injuries, especially lung, cardiac, brain, pelvic and abdominal injuries can make anesthesia complex and increases the morbidity and mortality.

Airway may be very difficult due to facial and neck injuries.

Presence of shock can significantly alter the outcome.

Sometimes emergency may be so acute that there is not enough time to prepare the operation theater.

Preoperative Period

Unlike other patients the preoperative period of trauma patients is often turbulent. The Involvement of anesthetist may begin from emergency room as a part of resuscitation.

If there is need, then airway must be secured and patient resuscitated before shifting to operation theater (OT). It is not uncommon to see intubated patients coming to OT. Although a systolic blood pressure of at least 80-90 mm Hg is recommended before induction, however, sometimes the situation like damage control surgery (surgery is the only method to stop bleeding) warrants the induction at very low or even non recordable blood pressure. The prognosis of such patients is very bleak.

It is very important to rule out major injuries especially:

Chest injury: 

Pneumothorax/hemo thorax or lung contusion.

Head injury:

The presence of head injury can alter the anesthesia technique. For example, central neuraxial blocks may be absolutely contraindicated with elevated intracranial tension (ICT) Spine injuries: Improper movements Can produce devastating complications including quadriplegia, paraplegia or even death.

Abdominal, pelvic injuries and major bone fractures, can produce massive hemorrhage.

As airway may be compromised detailed assessment of airway is must.

Try to obtain medical history as maximum as possible. Obtain adequate blood and blood products

Correct acute traumatic coagulopathy If fasting status cannot be obtained, pre medicate the patient with metoclopramide and ranitidine or sodium citrate.

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