Choice of General Anesthetics for Trauma Patients

Sikorski, Robert; Koerner, A. Ken; Fouché-Weber, L. Yvette; Galvagno, Samuel M.

doi:10.1007/s40140-014-0066-5

Cited by 19 publications

(16 citation statements)

References 65 publications

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“…While a full discussion of different medications and doses is outside of the scope of this article, a brief discussion of Damage control resuscitation common medications is depicted in Table 1. 32 In the hypotensive patient, lower doses of sedation are usually given while higher than normal doses of paralytics can be used to decrease the time to onset. 33 It is important, when possible, to briefly resuscitate patients before administrating any agent.…”

Section: Airway Managementmentioning

confidence: 99%

Damage control resuscitation

et al. 2020

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The United States Navy originally utilized the concept of damage control to describe the process of prioritizing the critical repairs needed to return a ship safely to shore during a maritime emergency. To pursue a completed repair would detract from the goal of saving the ship. This concept of damage control management in crisis is well suited to the care of the critically ill trauma patient, and has evolved into the standard of care. Damage control resuscitation is not one technique, but, rather, a group of strategies which address the lethal triad of coagulopathy, acidosis, and hypothermia. In this article, we describe this approach to trauma resuscitation and the supporting evidence base.

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Section: Airway Managementmentioning

confidence: 99%

Damage control resuscitation

et al. 2020

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“…A number of potential RSI agents are available, each with their own benefits and risk of adverse effects [ 14 ]. Suxamethonium is the neuromuscular blocking agent that has traditionally been used for RSI [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In terms of induction agents, thiopentone and propofol have been shown to cause significant hypotension, particularly in hypovolaemic patients [ 14 , 16 , 17 ]. Ketamine is a haemodynamically stable induction agent with potent analgesic properties [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia

et al. 2015

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IntroductionRapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium.MethodsWe performed a comparative cohort study of major trauma patients undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using etomidate and suxamethonium and Group 2 underwent RSI using fentanyl, ketamine and rocuronium. Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality.ResultsCompared to Group 1 (n = 116), Group 2 RSI (n = 145) produced significantly better laryngoscopy views (p = 0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p = 0.007). A hypertensive response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p < 0.0001). A hypotensive response was uncommon in both groups (1% versus 6%; p = 0.05). Only one patient in each group developed true hypotension (SBP < 90 mmHg) on induction.ConclusionsIn a comparative, cohort study, pre-hospital RSI using fentanyl, ketamine and rocuronium produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital trauma anaesthesia.

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“…Succinylcholine is known to increase ICP and intraocular pressure, which can be reduced by the use of lidocaine (1.5 mg/kg) before administration. It should not be used in eye and head trauma (6,50). Rocuronium is a nondepolarizing agent and IV dose is 0.5-0.8 mg/kg for intubation.…”

Section: General Anesthesiamentioning

confidence: 99%

“…However, it may cause chest wall rigidity (6,56). In many studies, it was emphasized that opioid use should be titrated according to the response (50). Midazolam, a fast acting benzodiazepine, provides sedation and amnesia.…”

Section: General Anesthesiamentioning

confidence: 99%

Approach to Patients with Neurotrauma and Thoracic Trauma and Anesthesia Management with Current Guidelines II

Mingir¹,

Berktaş²,

Türkmen³

et al. 2019

eamr

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Anesthesia Management in Trauma Trauma, which means wound in ancient Greek, is the leading cause of death in the 1-44 age group, and the third cause of death following cancer and cardiovascular disease in all age groups. Trauma is defined as tissue damage characterized by structural changes and physiological disorders due to mechanical, thermal, electrical and chemical energies, ionized or nuclear radiation or absence of essential elements of life such as oxygen and heat. Trauma has many reasons such as traffic accidents, work accidents and falling from height (1,2). These patients need a systematic anesthesia management in posttraumatic evaluation, airway management, resuscitation, possible preoperative and postoperative surgical process, intensive care follow-up and treatment (3). The nature of trauma, uncontrollable bleeding after trauma, coagulation anomalies, hypothermia, shock, acidosis disrupt the normal homeostatic mechanism. Acute coagulopathy caused by high blood loss in major traumas is often associated with poor clinical course in trauma patients (4,5). Another paradox is the nature of unexplained events, insufficient anamnesis information and the necessity of emergency intervention in trauma cases. Initial Assessment of Trauma Algorithms have been defined for systemic approach to trauma patients and more than fifty scoring systems have been developed. The Trauma score, which was defined in 1981 by adding respiratory rate and systolic blood pressure to the Triage index, is a widely used scoring system. It was revised in 1989 and Revised Trauma score was formed (Table 1). In order for the trauma centers to systematically engage a modern trauma approach in harmony between the other disciplines, it is necessary to establish national guidelines tailored to the needs and ensure their widespread use. Airway obstruction, severe hemorrhage and hypoxia due to tension pneumothorax may be among the causes of early death due to trauma (6-8). From the moment the trauma patient is met, the first step is to apply the

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Choice of General Anesthetics for Trauma Patients

Cited by 19 publications

References 65 publications

Damage control resuscitation

Damage control resuscitation

Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia

Approach to Patients with Neurotrauma and Thoracic Trauma and Anesthesia Management with Current Guidelines II

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