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Canadian Journal of Anaesthesia

, Volume 38, Issue 4, pp 506–510 | Cite as

Anaesthetic management of acute blunt thoracic trauma

  • J. Hugh Devitt
  • Richard F. McLean
  • Jean-Paul Koch
Occasional Reviews

Abstract

Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a nvo-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. Of these, 208 had blunt thoracic injuries while 125 did not have chest injuries. Both groups were similar with respect to age but patients with thoracic trauma had a greater ISS. (P < 0.05) and greater intraoperative mortality (P < 0.01). The aetiology of the intraoperative deaths with one exception was exsanguination. Emergency thoracotomy or sternotomy indicated a poor prognosis with a mortality rate of 80%. The most common intraoperative problem was an elevated airway pressure. Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.

Key words

anaesthesia: emergency complications: mortality, trauma, chest 

Résumé

Le Sunnybrook Health Science Centre est le centre de traumatologie adulte desservant le Toronto métropolitain. Nous avons revu les cas de traumatisme s fermés du thorax qui y furent admis depuis deux ans. Nous avons recensé 333 cas de traumatisme fermé important chez qui une intervention chirurgicale urgenle s’avéra nécessaire. On à dénombré parmi eux 208 traumatismes du thorax. L’âge moyen était le même qu’il y ait ou non implication thoracique toutefois, cette dernière entraînait un score de gravité moins rejouissant (P < 0,05) et une mortalité peropératoire plus grande (P < 0,01). Sauf exception, les décès peropératoire survenaient par exsanguination. Les thoracotomies et sternotomies d’urgence étaient de mauvais augure avec une mortalité de 80%. En peroperatoire, les pressions des voies respiratoires étaient souvent très élevées. Des voies respiratoires supérieures déformées et d’autres blessures laissant anticiper des dijficultés lors de l’intubation, nous out fait opter pour une intubation éveillée dans 77,5% des cas nécessitant une anesthésie. Enfin, après l’intervention chirurgicale nous avons dû ventiler mécaniquement 74% des patients. La presénce d’ un traumatisme fermé du thorax assombrit le pronostic des victimes daccident.

References

  1. 1.
    Bogetz MS, Katz JA. Recall of surgery after major trauma. Anesthesiol 1984; 61; 6–9.CrossRefGoogle Scholar
  2. 2.
    Rodriguez R, Herrin TJ, Hendrickson M. Cardiac and thoracic vascular injuries: anesthetic considerations. South Med J 1980; 73: 739–841.PubMedGoogle Scholar
  3. 3.
    Sloan JH, Kellerman AL, Roey DT et al. Handgun registration, crime, assaults and homicide: a tale of two cities. N Engl J Med 1988; 319: 1256–62.PubMedCrossRefGoogle Scholar
  4. 4.
    American Medical Association’s Committee on (he medical aspects of automotive safety. Rating the severity of tissue damage: the abbreviated scale. JAMA 1971; 215: 277.Google Scholar
  5. 5.
    Baker SP, O’Neil B, Haddon W et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–96.PubMedCrossRefGoogle Scholar
  6. 6.
    Clark GC, Schecter WP, Trunky DD. Variables affecting outcome in blunt chest trauma: Hail chest vs. pulmonary contusion. J Trauma 1988; 28; 298–303.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson JA, Cogbill TH, Winga ER. Determinants of outcome after pulmonary contusion. J Trauma 1986; 26: 695–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg 1982; 196: 481–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Bowe EA, Klien EF Jr. Pulmonary Contusion. Seminars in Anesthesia 1985; 4: 145–53.Google Scholar
  10. 10.
    Oppehnheimer L, Craveu KD, Forkert L, Wood LDH. Pathophysiology of pulmonary contusion of dogs. J App Physiol 1979; 47: 718–28.Google Scholar
  11. 11.
    Meschino A, Devitt JH, Schwartz ML, Koch JP. The safety of awake tracheal intubation in cervical spine injury. Can J Anaesth 1988; 35: S131.Google Scholar
  12. 12.
    Schulte-Sasse U, Hess W, Tarnow J. Pulmonary vascular responses to nitrous oxide in patients with normal and high pulmonary vascular resistance. Anesthesiogy 1982; 57: 9–13.CrossRefGoogle Scholar
  13. 13.
    Sutherland G, Calvin J, Driedger A, Holliday R, Sibbald W. Anatomic and cardiopulmonary response to trauma with associated blunt chest injury. J Trauma 1981; 21: 1–12.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • J. Hugh Devitt
    • 1
  • Richard F. McLean
    • 1
  • Jean-Paul Koch
    • 1
  1. 1.Department of Anaesthesia Sunnybrook Health Science CentreUniversity of TorontoCanada

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