Zusammenfassung
In der anästhesiologischen Praxis ist das Thoraxtrauma eine große Herausforderung. Verletzungen von Atemwegen, Lunge, Zwerchfell, Herz und großen thorakalen Gefäßen sind die vorherrschenden Probleme. Art und Ausmaß des chirurgischen Eingriffs sowie Wirkungen von Anästhetika und mechanischer Ventilation auf die pulmonale und kardiale Funktion sind besonders zu beachten.
Abstract
In daily practice, management of patients with blunt thoracic trauma is challenging for the anesthetist. Injuries of airways, lungs, diaphragm, heart and large vessels are the main difficulties.
Respiratory and circulatory physiology in general is affected by general anesthesia, which may result in an increased number of perioperative complications. Therefore, anesthetic management of patients with thoracic trauma needs to address different clinical topics: management of difficult airways, intrinsic effects of anesthetics and mechanical ventilation on respiratory and cardiac function, the adequate replacement of blood loss as well as type and extent of the surgical intervention. Postoperatively, sufficient pain therapy avoids pulmonary complications and can improve outcome.
Therefore, a high degree of (patho-)physiological understanding and manual skills are required in this scenario. Interdisciplinary cooperation during diagnostic, treatment and in the perioperative course is a prerequisite for a successful management.
The present work describes the main characteristics of thoracic trauma and discusses important precautions and typical problems the anesthetist has to face in the clinical setting.
Schlüsselwörter
stumpfes Thoraxtrauma - perforierende Thoraxverletzung - anästhesiologisches Management - präoperative Evaluation - Schmerztherapie
Key words
blunt thoracic trauma - penetrating thoracic injury - anesthetic management - preoperative evaluation - pain therapy
