Traumatic injury refers to physical injuries of sudden onset and severity that require immediate medical attention.1 The trauma patient may have systemic shock and necessitate resuscitation or limb-saving interventions.1 Traumatic injuries can result from blunt, penetrating or burning incidents, including motor vehicle collisions, sports injuries, falls and natural disasters occurring at home, at work or outside.1 Perhaps because it has so many causative agents, trauma is one of the leading causes of death and disability in the United States.2 For children and adults under age 45, trauma accounts for an estimated 79,000 deaths per year.3 Depending on the quality of care that trauma patients receive, there can be a wide variety of outcomes, including mortality.4 Thus, the combined efforts of emergency response agents and post-resuscitation providers can make the difference between a trauma patient’s life or death.4 Trauma anesthesiology is a subspecialty of anesthesiology that focuses on care for patients who have sustained traumatic injuries.5 Given their place on the trauma team, trauma anesthesia providers must know their particular roles and challenges, as well as current practices in trauma anesthesiology.
Trauma anesthesiology requires a skill set that builds off many specialties in anesthesiology.5 Trauma anesthesia providers must understand critical care, regional anesthesia and pain management to help patients survive the perioperative period.5 Additionally, trauma anesthesia professionals participate in a multidisciplinary approach to care, often interacting with providers from specialties such as surgery, anesthesiology, critical care emergency medicine, orthopedics, neurosurgery, ophthalmology, otolaryngology, plastic surgery, urology, radiology, cardiac surgery and blood banking.6 In trauma anesthesiology, work is not limited to the operating room, but rather extends to combat,7 pre-hospital, emergency department, interventional radiology and hospital ward settings.5 Clearly, trauma anesthesiology involves a number of skills, collaboration and the ability to remain calm in stressful situations.
The anesthesia provider’s immediate presence upon the patient’s arrival to the hospital is crucial for early airway management, precise resuscitation, effective analgesia and sedation provision and seamless transfer to the operating room.5 The trauma anesthesiologist must first assess the patient’s airway, breathing, circulation, hemorrhage control, neurological function and temperature.6 The next survey involves more thorough investigations through scans and ultrasounds.6 After evaluating the patient’s medical history and risk of airway difficulties or aspiration, the anesthesia provider’s role entails premedication, vital signs monitoring, choice of anesthetic agent, induction and maintenance of anesthesia, extubation and postoperative management and ventilation.6 For patients who have had a traumatic brain injury, the trauma anesthesiology professional must be on the lookout for hypotension and/or hypoxemia.6 All of these steps should occur as soon as possible after the injury in order to reduce risk of mortality.6 Trauma anesthesia professionals must provide fast-paced, accurate care to patients to save their limbs and even their lives.5
An important aspect of trauma anesthesiology is the type of anesthesia used. After trauma, patients can suffer poor psychological or physical effects, including complex regional pain syndrome, post-amputation pain and post-traumatic stress disorder (PTSD).8 The trauma anesthesia provider and the type of anesthetic drug used after trauma may play crucial roles in helping patients overcome these long-term effects. For example, according to a review by Gregoretti et al., regional anesthesia for trauma surgery and injury-related pain may reduce risk of post-traumatic stress disorder compared to general anesthesia.9 Regional anesthesia techniques offer advantages over general anesthesia, as they simplify transport of injured patients10 and reduce side effects.11 They are safe and easy to use, and lead to decreased opioid requirements.11 Additionally, regional anesthesia is more widely available in challenging environments, such as military conflicts and natural disasters.8 While Fleming et al.’s review states that peripheral nerve block is safer and more practical than neuraxial techniques in trauma patients,8 Gadsden and Warlick show that they are both effective for anesthesia and analgesia.11 Meanwhile, Aboseif suggests that general anesthesia be used for trauma patients who are hemodynamically unstable,6 and Sikorski et al. give recommendations on types of general anesthesia that can be used in such patients.12 More research is needed to assess the value of regional versus general anesthetic agents in various trauma situations.
Traumatic injury is a leading cause of morbidity and mortality, and trauma clinicians often have patients’ lives in their hands. Trauma anesthesiology requires knowledge of many medical specialties and multidisciplinary collaboration. The trauma anesthesia provider must perform a preoperative evaluation, intraoperative monitoring and postoperative care within a limited time frame. Though some research exists on the advantages of regional anesthesia over general anesthesia, future studies should focus on the effects of anesthesia type on PTSD and chronic pain outcomes.11 Additionally, health care policymakers and anesthesiology organizations should emphasize training in trauma anesthesiology in order to fill the need for more practitioners.5
1. Traumatic Injury. UF Health. Web: University of Florida Health; January 16, 2020.
2. DiMaggio C, Ayoung-Chee P, Shinseki M, et al. Traumatic injury in the United States: In-patient epidemiology 2000-2011. Injury. 2016;47(7):1393–1403.
3. Houry D. Saving Lives and Protecting People From Injuries and Violence. Annals of Emergency Medicine. 2016;68(2):230–232.
4. Minei JP, Schmicker RH, Kerby JD, et al. Severe traumatic injury: Regional variation in incidence and outcome. Annals of Surgery. 2010;252(1):149–157.
5. ASA House of Delegates/Executive Committee. Statement of Principles: Trauma Anesthesiology. Web: American Society of Anesthesiologists; October 16, 2013.
6. Aboseif E. Role of anesthesiologists in the management of trauma patients: Updates. Ain-Shams Journal of Anaesthesiology. 2016;9(2):153–158.
7. Tobin JM, Barras WP, Bree S, et al. Anesthesia for Trauma Patients. Military Medicine. 2018;183(S2):32–35.
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11. Gadsden J, Warlick A. Regional anesthesia for the trauma patient: improving patient outcomes. Local and Regional Anesthesia. 2015;8:45–55.
12. Sikorski RA, Koerner AK, Fouche-Weber LY, Galvagno SM. Choice of General Anesthetics for Trauma Patients. Current Anesthesiology Reports. 2014;4(3):225–232.