Update in trauma anesthesiology: Perioperative resuscitation management

Joshua M. Tobin, Albert J. Varon

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. Resuscitation with packed red blood cells and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive pharmacologic therapy can assist with resuscitation. Tranexamic acid is used in Europe with good results, but the drug is slowly being added to the pharmacy formulary of trauma centers in United States. Recombinant factor VIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit.

Original languageEnglish
Pages (from-to)1326-1333
Number of pages8
JournalAnesthesia and Analgesia
Volume115
Issue number6
DOIs
StatePublished - Dec 1 2012

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Anesthesiology
Resuscitation
Wounds and Injuries
Trauma Centers
Tranexamic Acid
Formularies
Therapeutics
Vasopressins
Sepsis
Erythrocytes
Clinical Trials
Hemorrhage
Survival
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Update in trauma anesthesiology : Perioperative resuscitation management. / Tobin, Joshua M.; Varon, Albert J.

In: Anesthesia and Analgesia, Vol. 115, No. 6, 01.12.2012, p. 1326-1333.

Research output: Contribution to journalArticle

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