Anesthesia for Trauma Patients

Summary of Changes

01 Sep 2023 update: DEVICE data regarding video laryngoscope.

June 2023 update

- Calcium administration changed to 1 gram calcium
- Tranexamic acid (TXA) 2gm bolus is now favored over the traditional 1gm prehospital bolus followed by 1gm infusion over 8 hours. The 2gm TXA bolus should be given as close to the time of injury as possible and not outside of the 3 hours window.

05 Apr 2021 updates

1. Use Whole Blood (WB) if available. FDA-approved cold stored WB is preferred over fresh WB (non-FDA approved).
2. Initiate infusion of 2gmTranexamic Acid (TXA) IV/IO ASAP or within 3 hours of injury
3. Carefully follow calcium concentration during massive transfusion. Consider giving empiric calcium if hypotensive
4. Stronger evidence exists for use of vasopressin in hemorrhagic shock. Consider vasopressin bolus of 2-4 units followed by a vasopressin infusion (0.04 U/min) in cases of refractory shock.

Background

Resuscitation goals for trauma patients have undergone significant change in the past decade. Appropriate blood product transfusion ratios, use of pharmacologic adjuncts (e.g., TXA) and other modalities have improved survival for the wounded combatant. In the operating room (OR), resuscitation occurs in the context of providing an anesthetic which minimizes hemodynamic instability in the severely injured patient. It is imperative, therefore, that the management of this resuscitation occurs simultaneously with surgery and anesthesia. While recent review articles, checklists and textbooks have drawn attention to the role of anesthetic resuscitation concurrent with surgical correction of injury, there is no guideline for the induction, maintenance, and transfer of anesthetic care of the military trauma patient in extremis.1-4