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


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 


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.


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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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