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Anesthetic Management of Thoracic Trauma

  • Sudeep Goyal
  • Bhuwan Chand Panday
Chapter
  • 21 Downloads

Abstract

Our thoracic cavity harbors the most important vital structure of the body. It is bounded by ribs which is a strong protective covering of organs with paramount importance. It requires a great force to disrupt this wall and injure the underlying structures. Injury to thorax is related to have a high incidence of morbidity and is the leading cause of death at young age (1–45 years) [1], and also the predominant cause of “years of life lost” before achieving 75 years of age [2]. These accounts for 25–50% of all trauma-related mortality [3, 4]. In majority (70%) of cases, this devastating injury to the chest is associated with multisystem injuries.

References

  1. 1.
    Bergen G, Chen LH, Warner M, et al. Injury in the United States: 2007 Chartbook. Hyattsville, MD: National Center for Health Statistics; 2008.Google Scholar
  2. 2.
    Fingerhaut LA, Warner M. Injury Chartbook. Health, United States, 1996–1997. Hyattsville, MD: National Center for Health Statistics; 1998.Google Scholar
  3. 3.
    National Center for Injury Prevention and Control. Available from: http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html Atlanta, GA. Accessed 30 June 2009.
  4. 4.
    Moloney JT, Fowler SJ, Chang W. Anesthetic management of thoracic trauma. Curr Opin Anaesthesiol. 2008;21(1):41–6.CrossRefGoogle Scholar
  5. 5.
    Orliaguet G, Ferjani M, Riou B. The heart in blunt trauma. Anesthesiology. 2001;95(2):544–8.CrossRefGoogle Scholar
  6. 6.
    Gerhardt MA, Gravlee GP. Anesthesia considerations for cardiothoracic trauma. In: Smith CE, editor. Trauma anesthesia. Cambridge, New York: Cambridge University Press; 2008. p. 279–99.Google Scholar
  7. 7.
    DePalma RG, Burris DG, Champion HR, et al. Blast injuries. N Engl J Med. 2005;352(13):1335–42.Google Scholar
  8. 8.
    American College of Surgeons. Committee on Trauma. Advanced trauma life support program for doctors: ATLS. 7th ed. Chicago, IL: American College of Surgeons; 2004.Google Scholar
  9. 9.
    Herzig D, Biffl WL. Thoracic trauma. In: Fink MP, editor. Textbook of critical care. 5th ed. Philadelphia, PA: Elsevier Saunders; 2005. p. 2077–87.Google Scholar
  10. 10.
    Casos SR, Richardson JD. Role of thoracoscopy in acute management of chest injury. Curr Opin Crit Care. 2006;12(6):584–9.CrossRefGoogle Scholar
  11. 11.
    Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma. 1999;46:543–51.CrossRefGoogle Scholar
  12. 12.
    Kirkpatrick AW, Ball CG, D’Armours SK, et al. Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Can J Surg. 2008;5(1):57–69.Google Scholar
  13. 13.
    Hakuba T, Minato N, Minematsu T, et al. Surgical management and treatment of traumatic right atrial rupture. Gen Thorac Cardiovasc Surg. 2008;56(11):551–4.Google Scholar
  14. 14.
    Lim R, Gill IS, Temes RT, et al. The use of adenosine for repair of penetrating cardiac injuries: a novel method. Ann Thorac Surg. 2001;71:1714–5.Google Scholar
  15. 15.
    Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.CrossRefGoogle Scholar
  16. 16.
    Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615–25.CrossRefGoogle Scholar
  17. 17.
    Reiestad F, Kvalheim L. Continuous intercostal nerve block for postoperative pain relief. Tidsskr Nor Laegeforen. 1984;104(7):485–7.PubMedGoogle Scholar
  18. 18.
    Rocco A, Reiestad F, Gudman J, et al. Intrapleural administration of local anaesthetics for pain relief in patients with multiple rib fractures: preliminary report. Reg Anesth. 1987;12(1):10–4.Google Scholar
  19. 19.
    Moon MR, Luchette FA, Gibson SW, et al. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg. 1999;229(5):684–91. Discussion 691–682CrossRefGoogle Scholar
  20. 20.
    Luchette FA, Radafshar SM, Kaiser R, et al. Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma. J Trauma. 1994;36(6):865–9. Discussion 869–870Google Scholar
  21. 21.
    Dittmann M, Keller R, Wolff G. A rationale for epidural analgesia in the treatment of multiple rib fractures. Intensive Care Med. 1978;4(4):193–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Sudeep Goyal
    • 1
  • Bhuwan Chand Panday
    • 1
  1. 1.Institute of Anaesthesiology, Pain and Perioperative MedicineSir Ganga Ram HospitalNew DelhiIndia

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