Most patients with chest trauma can be successfully treated with tube thoracostomy and appropriate pain medication. Initial care of these patients is usually straightforward and performed by an emergency doctor or an emergency room surgeon, e.g. a general surgeon. If more extensive therapy of these polytraumatized patients appears to be required, tertiary care should be done in specialized centers or clinics with network structures. An appropriate structured network of surgical centers guarantees sufficient and efficient care of patients with severe chest trauma. In a best-case scenario the specialist disciplines work in a rendezvous system with close cooperation. Early communication with a thoracic surgeon is essential to minimize mortality and long-term morbidity. Improvement in understanding the underlying molecular physiological mechanisms involved in the various traumatic pathological processes and the advancement of diagnostic techniques, minimally invasive approaches and pharmacologic therapy, will contribute to decreasing morbidity of these critically injured patients.

The results suggest that low-dose rocuronium provided better patient satisfaction and less POM. But with the use of low-dose succinylcholine, the intubating conditions are more comfortable, and it is less expensive than rocuronium/sugammadex.

Zusammenfassung Ein Pneumothorax ist definiert, als eine Luftansammlung im Pleuraspalt. Man unterscheidet zun?chst zwischen einem prim?ren idiopathischem (PSP) und einem sekund?ren Spontanpneumothorax (SSP). Weiterhin werden noch der iatrogene und der traumatische Pneumothorax unterschieden. Der PSP tritt ohne erkennbares Trauma und ohne zugrunde zu liegende Lungenerkrankung auf und am h?ufigsten sind junge, asthenischer M?nner betroffen. Der SSP hingegen hat in den meisten F?llen eine manifeste Lungenger?sterkrankung als Ursache und ist bei ?lteren Patienten (?>?50?Jahre) am h?ufigsten. Raucher haben ein erh?htes Risiko, einen Pneumothorax zu entwickeln. Die meisten Pneumothoraces erfordern eine therapeutische Intervention mittels Thoraxdr?nage und nur ein kleiner Teil der Patienten kann beobachtet werden. Entgegen einiger Therapieempfehlungen zeigte sich in der klinischen Anwendung der einfachen Nadelaspiration kein Behandlungsvorteil. Alle Patienten mit einem symptomatischen Pneumothorax m?ssen mit einer schnellstm?glich eingelegten Thoraxdr?nage in den Pleuraspalt therapiert werden. In der operativen Behandlung des Pneumothorax geh?rt die VATS zur derzeitigen Standardtherapie und nur in Ausnahmef?llen und Komplikationen wird die posterolaterale Thorakotomie dem minimalinvasiven Verfahren vorgezogen. Beide Operationen haben die Zielsetzung, die Rezidivrate des Pneumothoraxes m?glichst gering zu halten.

Background: Thoracotomy leads to acute and chronic post-thoracotomy pain (CPTP). The purpose of this study was to investigate the effect of magnesium sulphate (MgSO 4) administered perioperatively on acute postoperative and CPTP syndrome. Methods: One hundred patients were enrolled in this prospective, observational study. Analgesic medication was provided according to the World Health Organization pain relief ladder (control group). The study group received additionally MgSO 4 (40 mg/kg over 10 minutes) during induction of anesthesia followed by an infusion over 24 hours (10 mg/kg/h). The presence and severity of pain were assessed before surgery, on postsurgical days 1-8, 30 and 90, respectively. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was used pre-and postoperatively for documentation of neuropathic pain. The incidence and severity of CPTP were assessed by a telephone survey 30 and 90 days after surgery. Results: Numerical rating scale (NRS) pain scores at rest were significantly lower in the study group receiving MgSO 4 at days 1 to 8 (P<0.05). Thirty days after surgery, 2.1% of the MgSO 4-patients had a LANSS score ≥12 compared to 14.3% in the control group (P=0.031). No patient had a LANSS score ≥12 in the study group compared to the control group (0% vs. 12.2%, P<0.05) 90 days following surgery. Conclusions: MgSO 4 administration reduces postoperative pain at rest according to the NRS pain scores and is effective in preventing chronic neuropathic post-thoracotomy pain measured by LANSS score. Prospective-randomized trials are needed to confirm the results of the present study.

Severe intrathoracic injuries are uncommon but immediately life-threatening. These injuries are mostly associated with polytrauma. After stabilization of polytraumatized patients imaging is a prerequisite for treatment and operation planning. The assessment warrants an interdisciplinary approach primarily between the specialties of anesthesia, trauma surgery and thoracic surgery and further specialties should be involved depending on the injury pattern. This article gives an overview about the current management of the most important intrathoracic injuries.