Canadian Journal of Anesthesia, Vol 14, 49-58, Copyright © 1967 by Canadian Anesthesiologists' Society

Anaesthesia for the Patient with Multiple Injuries: Some Problems Concerning Anaesthetic Management Illustrated by a Case Report

¹ Department of Anaesthesia, University of Western Ontario, London, Ontario

Patients with multiple injuries present complex and challenging problems to the anaesthetist. Constant vigilance and rapid recognition and treatment of complications are essential. The anaesthetist should be a member of the team that manages the patient and should attend the patient from the time of his admission to hospital. He should be actively interested in the management of severely traumatized patients and become familiar with the recognition and management of complications affecting parameters of ventilation and circulation.

The presence of pulmonary contusion and the often severe reduction in oxygen tension caused by this condition should be considered in every case of unexplained dyspnoea and cyanosis. Pneumothorax is an ever-present danger. Assessment of the venous pressure is extremely helpful for the management of circulatory problems. The external jugular vein is a readily accessible avenue for infusion. Enormous extravasations can occur and require massive replacement of blood; low molecular weight dextran may be useful initially. Surgical procedures must be aimed at restoration of vital functions and the prevention of further damage. Intensive therapy is required postoperatively for prolonged periods, and in this the anaesthetist plays an important role.

For the anaesthetic management, minimal anaesthesia with high oxygen concentrations should be used. In our experience Innovar can be very satisfactory under these circumstances.

Note:

Presented at the Annual Fall Meeting of the Section on Anaesthesia, Ontario Medical Association, Hamilton, Ontario, October 14 and 15, 1966.