Selective Use of Anesthetics in Patients with Major Trauma

Abstract

This chapter offers a key foundation for the anesthetic care of the trauma patient so that the surgical and anesthetic teams may coordinate care to increase the chances for a meaningful recovery for the patient. The anesthesiologist plays an integral role in the care of the patient following traumatic injury that spans multiple phases of care: arrival in the trauma bay; initial stabilization and resuscitation; management of general anesthesia; postoperative intensive care; and pain management. The physiologic derangements associated with trauma begin at the moment of injury and have often manifested by the time the patient arrives in the emergency department. Medications for airway management and the induction and maintenance of general anesthesia should be carefully selected according to the patient’s clinical status. Resuscitation of shock should be directed at identifying and correcting the underlying pathology. In the interim, treatment should be tailored based on vital signs, laboratory values, and point-of-care testing. Hemorrhagic shock is the most common etiology of shock in trauma and is best addressed with a balanced resuscitation with blood products and with constant vigilance regarding impending sequelae of vascular and organ injury that may complicate management. Special populations, such as patients with traumatic brain injury or burns, or patients who are pregnant, require particular considerations from an anesthetic standpoint.