Anaesthesia for trauma patients

Abstract

Anaesthesia for trauma patients presents unique challenges for anaesthetists. Most urgent cases occur at night or during weekend shifts, when more experience anaesthetists are not available. Patient information is limited, and previous medical history and details of chronic medication, allergies, or genetic abnormalities, are unknown. Patients often present intoxicated, with a full stomach, and with the potential for cervical spine instability. Patients often have multiple injuries, requiring several procedures, sometimes in different positions. A difficult airway is not unusual, and special airway management equipment may be required at short notice. Occult injuries, such as tension pneumothorax or cardiac tamponade, can manifest at unexpected times. The management of trauma patients may require the participation of a multidisciplinary team, namely a trauma surgeon, orthopaedic surgeon, neurosurgeon, plastics surgeon, vascular surgeon, radiologist, laboratory technician, blood bank technician, intensivist, and of course, the anaesthetist, who will continue the resuscitation, already in progress, and whose role is fundamental to the final outcome of the patient. Trauma patients often present as emergencies in small community hospitals with limited resources, where the multidisciplinary team is all but absent. This review provide an overview of important areas of trauma care for the anaesthesiologist. It begins with the principles of initial resuscitation, followed by discussion of emergency airway management, induction of general anaesthesia, and new concepts regarding the management of acute and massive bleeding.