Anesthetic Considerations

In recent years, road traffic accidents (RTAs) have become the leading cause of death. RTAs may lead to serious injuries that may involve the CNS, airway, chest, neck, abdominal viscera, major vessels, long bones, etc. Hypoxia is the biggest killer in an RTA victim, and hence, securing the airway and ensuring oxygenation should be the priority in every RTA patient. American Society of Anaesthesiologists Committee on Trauma and Emergency Preparedness guidelines for airway management can help in taking quick decisions. Pre-existing medical conditions can affect the perioperative outcome; hence, every effort should be made to identify pre-existing medical conditions by contacting the patient’s primary care physician or family members. Commonly, RTAs happen under the influence of intoxicants. These intoxicants can affect the pharmacokinetics and pharmacodynamics of the anesthetics in a major way. All trauma victims should be considered hemodynamically unstable and to have a low intravascular volume. A fluid strategy containing both colloids and crystalloids needs to be followed. Albumin should be the colloid of choice, blood and blood products should be made available as soon as possible. Trauma patients undergoing surgery are at a great risk of developing hypothermia. A lung protective ventilation strategy should be followed while ventilating trauma patients, especially if chest trauma is present. In patients with severe injury to the lung or the airway, extracorporeal membrane oxygenation (ECHMO) may be a viable option. Apart from intrathoracic bleeding, blunt trauma to the chest may cause cardiac contusion, which may manifest as minor dysrhythmias or may cause severe myocardial dysfunction. Patients with ongoing hemoptysis should be kept in lateral decubitus with the bleeding side down. Neurotrauma has special anesthesia considerations. Inhalational agents may cause an increase in cerebral blood flow (CBF) and increased intracranial pressure (ICP). Cervical spinal injury and high thoracic spinal injury may cause neurogenic shock or autonomic dysreflexia, which may have life-threatening implications. RTAs may be associated with inhalational burn injuries; inhalational injuries can occur with or without cutaneous burn injuries. Wheezing, stridor, hoarseness and tachypnoea are features of significant inhalational injury. Airway edema usually worsens beyond 18 h after the initial insult; hence, the airway must be secured before the airway edema sets in or worsens. Pregnant patients are a special category of patients and at a higher than usual risk of complications.