ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

TRAUMA AND EMERGENCY ANESTHESIA

Kevser Yamen Karaca

İstanbul Physical Therapy and Rehabilitation Training and Research Center, Department of Anesthesiology and Reanimation, İstanbul, Türkiye

Yamen Karaca K. Trauma and Emergency Anesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.419-430.

ABSTRACT

  • Trauma is the leading cause of death in individuals aged 1-44 and poses a higher risk in the elderly due to frailty.
  • The ATLS protocol provides a standardized approach to trauma management, with anesthesiologists playing a critical role in airway management, hemodynamic stabilization, and resuscitation.
  • Airway management requires early assessment and intervention; difficult airway risk should be anticipated, and surgical airway access should be performed when necessary.
  • Hypovolemia and hemorrhage control are key components of trauma management; excessive fluid administration without hemostasis may lead to coagulopathy.
  • Trauma-induced coagulopathy (TIC) is associated with hypofibrinogenemia and hyperfibrinolysis; early administration of tranexamic acid is recommended.
  • In traumatic brain injury (TBI), intracranial pressure should be controlled with sedation and osmotherapy.
  • In spinal cord injuries, spinal perfusion should be maintained by keeping the mean arterial pressure (MAP) between 85-90 mmHg.
  • In burn patients, early endotracheal intubation is essential due to the risk of airway edema, and fluid resuscitation should be carefully managed.
  • In pediatric trauma, children exhibit greater shock resistance, but hypotension is a late sign; tachycardia and capillary refill time should be closely monitored.
  • In pregnant trauma patients, the left lateral position is recommended to prevent aortocaval compression, and continuous fetal heart monitoring should be ensured.

Keywords: Anesthesia; Injuries; Acut care surgery; Resuscitation; Brain injuries; Traumatic

Referanslar

  1. Alnsour TM, Altawili MA, Alhoqail AM, Alzaid FY, Aljeelani YO, Alanazi AM, et al. Anesthesia Management in Emergency and Trauma Surgeries: A Narrative Review. Cureus. 2024;16(8):e66687. [Crossref]  [PMC]
  2. Brasel KJ. Advanced trauma life support (ATLS (R)): the ninth edition. 2013. [Link]
  3. Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. Journal of Trauma and Acute Care Surgery. 2007;63(6):1338-47. [Crossref]  [PubMed]
  4. Kool DR, Blickman JG. Advanced Trauma Life Support®. ABCDE from a radiological point of view. Emergency radiology. 2007;14:135-41. [Crossref]  [PubMed]  [PMC]
  5. Sharma V, Sreedhar C, Debnath J. Combat radiology: challenges and opportunities. Medical Journal Armed Forces India. 2017;73(4):410-3. [Crossref]  [PubMed]  [PMC]
  6. Kirkpatrick AW, Ball CG, D'Amours SK, Zygun D. Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Canadian Journal of Surgery. 2008;51(1):57. [PMC]
  7. Sternbach GL. The Glasgow coma scale. The Journal of emergency medicine. 2000;19(1):67-71. [Crossref]  [PubMed]
  8. Butterworth Iv JF, Mackey DC, Wasnick JD. Morgan & Mikhail's Clinical Anesthesiology, 7e. New York, NY: McGraw-Hill Education; 2022. [Link]
  9. Walls RM, Murphy MF. Manual of emergency airway management: Lippincott Williams & Wilkins; 2008. [Link]
  10. Eugene V, Hutzler J, Kempema J, Bradford J, Brown CV. The difficult airway in trauma: What you need to know. Journal of Trauma and Acute Care Surgery. 2023:10.1097. [Link]
  11. Kovacs G, Sowers N. Airway management in trauma. Emergency Medicine Clinics. 2018;36(1):61-84. [Crossref]  [PubMed]
  12. Engstrom K, Brown CS, Mattson AE, Lyons N, Rech MA. Pharmacotherapy optimization for rapid sequence intubation in the emergency department. The American Journal of Emergency Medicine. 2023;70:19-29. [Crossref]  [PubMed]
  13. Baekgaard JS, Eskesen TG, Moo Lee J, Ikast Ottosen C, Bennett Gyldenkærne K, Garoussian J, et al. Ketamine for rapid sequence intubation in adult trauma patients: a retrospective observational study. Acta Anaesthesiologica Scandinavica. 2020;64(9):1234-42. [Crossref]  [PubMed]
  14. Leede E, Kempema J, Wilson C, Tovar AJR, Cook A, Fox E, et al. A multicenter investigation of the hemodynamic effects of induction agents for trauma rapid sequence intubation. Journal of Trauma and Acute Care Surgery. 2021;90(6):1009-13. [Crossref]  [PubMed]
  15. Dao AQ, Mohapatra S, Kuza C, Moon TS. Traumatic brain injury and RSI is rocuronium or succinylcholine preferred? Current Opinion in Anesthesiology. 2023;36(2):163-7. [Link]
  16. Galvagno SM, Nahmias JT, Young DA. Advanced trauma life support® update 2019: management and applications for adults and special populations. Anesthesiology clinics. 2019;37(1):13-32. [Crossref]  [PubMed]
  17. Açıkalın A, Kozacı N, Acehan S, Gülen M, Sebe A. Travma olgularında sıvı resüsitasyonu. Arşiv Kaynak Tarama Dergisi. 2011;20(2):89-106. [Link]
  18. Keçik Y. Temel Anestezi. 2 ed: Güneş Tıp Kitabevleri; 2016. [Link]
  19. Moore HB, Gando S, Iba T, Kim PY, Yeh CH, Brohi K, et al. Defining trauma-induced coagulopathy with respect to future implications for patient management: communication from the SSC of the ISTH. Journal of Thrombosis and Haemostasis. 2020;18(3):740-7. [Crossref]  [PubMed]
  20. Guth MC, Kaufner L, Kleber C, von Heymann C. Therapy of trauma-induced coagulopathy-what is the evidence? Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS. 2012;47(9):528-39; quiz 40. [Crossref]  [PubMed]
  21. Murthi SB, Dutton RP, Edelman BB, Scalea TM, Hess JR. Transfusion medicine in trauma patients. Expert review of hematology. 2008;1(1):99-109. [Crossref]  [PubMed]  [PMC]
  22. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. Management of bleeding following major trauma: an updated European guideline. Critical care. 2010;14:1-29. [Crossref]  [PubMed]  [PMC]
  23. Rugeri L, Levrat A, David J, Delecroix E, Floccard B, Gros A, et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. Journal of Thrombosis and Haemostasis. 2007;5(2):289-95. [Crossref]  [PubMed]
  24. Brill JB, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, et al. The role of TEG and ROTEM in damage control resuscitation. Shock. 2021;56(1S):52-61. [Crossref]  [PubMed]  [PMC]
  25. Roubinian N. TACO and TRALI: biology, risk factors, and prevention strategies. Hematology 2014, the American Society of Hematology Education Program Book. 2018;2018(1):585-94. [Crossref]  [PubMed]  [PMC]
  26. Ghneim MH, O'Connor JV, Scalea TM. Damage control thoracic surgery: What you need to know. Journal of Trauma and Acute Care Surgery. 2023:10.1097. [Link]
  27. James V. Damage control thoracic surgery. Journal of Cardiothoracic Trauma. 2016;1(1):8-11. [Crossref]
  28. Wiles M. Management of traumatic brain injury: a narrative review of current evidence. Anaesthesia. 2022;77:102-12. [Crossref]  [PubMed]
  29. Hossain I, Rostami E, Marklund N. The management of severe traumatic brain injury in the initial postinjury hours-current evidence and controversies. Current opinion in critical care. 2023;29(6):650-8. [Crossref]  [PubMed]  [PMC]
  30. Jeffcote T, Ho K. Associations between cerebrospinal fluid protein concentrations, serum albumin concentrations and intracranial pressure in neurotrauma and intracranial haemorrhage. Anaesthesia and intensive care. 2010;38(2):274-9. [Crossref]  [PubMed]
  31. Park C, Moor P, Birch K, Shirley P. Operational anaesthesia for the management of traumatic brain injury. BMJ Military Health. 2010;156(Suppl 4):S335-41. [Crossref]  [PubMed]
  32. Hawryluk GW, Citerio G, Hutchinson P, Kolias A, Meyfroidt G, Robba C, et al. Intracranial pressure: current perspectives on physiology and monitoring. Intensive care medicine. 2022;48(10):1471-81. [Crossref]  [PubMed]
  33. Sviri GE, Aaslid R, Douville CM, Moore A, Newell DW. Time course for autoregulation recovery following severe traumatic brain injury. Journal of neurosurgery. 2009;111(4):695-700. [Crossref]  [PubMed]
  34. Dooney N, Dagal A. Anesthetic considerations in acute spinal cord trauma. International Journal of Critical Illness and Injury Science. 2011;1(1):36-43. [Crossref]  [PubMed]  [PMC]
  35. Barak M, Bahouth H, Leiser Y, Abu El-Naaj I. Airway management of the patient with maxillofacial trauma: review of the literature and suggested clinical approach. BioMed research international. 2015;2015(1):724032. [Crossref]  [PubMed]  [PMC]
  36. Harbin KR, Norris TE. Anesthetic management of patients with major burn injury. AANA journal. 2012;80(6). [Link]
  37. Bittner EA, Shank E, Woodson L, Martyn JJ. Acute and perioperative care of the burn-injured patient. Survey of Anesthesiology. 2015;59(3):117. [Crossref]
  38. Hill NE, Mahboobi SK. Anesthesia for patients with burns. StatPearls [Internet]: StatPearls Publishing; 2023. [Link]
  39. Pham TN, Cancio LC, Gibran NS. American Burn Association practice guidelines burn shock resuscitation. Journal of burn care & research. 2008;29(1):257-66. [Crossref]  [PubMed]
  40. Ross AK. Pediatric trauma: anesthesia management. Anesthesiology Clinics of North America. 2001;19(2):309-37. [Crossref]  [PubMed]
  41. Aichholz P, Ng IC, Henry MN, Muldowney M, Nathwani RV. Pediatric Trauma Assessment, Resuscitation, Anesthesia care and Beyond. Current Anesthesiology Reports. 2024:1-12. [Crossref]
  42. Moon TS, Sappenfield J. Anesthetic management and challenges in the pregnant patient. Current Anesthesiology Reports. 2016;6(1):89-94. [Crossref]
  43. Pacheco LD, Gei AF, VanHook JW, Saade GR, Hankins GD. Burns in pregnancy. Obstetrics & Gynecology. 2005;106(5 Part 2):1210-2. [Crossref]  [PubMed]
  44. De Simone B, Chouillard E, Podda M, Pararas N, de Carvalho Duarte G, Fugazzola P, et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World journal of emergency surgery. 2024;19(1):18. [Link]
  45. Lewis MC, Abouelenin K, Paniagua M. Geriatric trauma: special considerations in the anesthetic management of the injured elderly patient. Anesthesiology clinics. 2007;25(1):75-90. [Crossref]  [PubMed]
  46. Muldowney M, Aichholz P, Cox M, Bentov I. Perioperative Management of the Geriatric Trauma Patient. Current Anesthesiology Reports. 2025;15(1):1-11. [Crossref]
  47. Mahender A, Chavan SS, Saroa R, Chauhan M. Recent advances in geriatric anaesthesia. Indian Journal of Anaesthesia. 2023;67(1):152-8. [Crossref]  [PubMed]  [PMC]
  48. Ang D, Kurek S, McKenney M, Norwood S, Kimbrell B, Barquist E, et al. Outcomes of geriatric trauma patients on preinjury anticoagulation: a multicenter study. The American surgeon. 2017;83(6):527-35. [Crossref]  [PubMed]