Anesthesia for Trauma

Many trauma patients will be hypovolemic, thus consider induction with ketamine (1-2 mg/kg) or etomidate (0.2-0.3 mg/kg) – also consider adding midazolam (induction dose 0.1-0.4 mg/kg), as the incidence of intraoperative recall is high in trauma patients. Most trauma patients cannot handle the same level of anesthesia as their healthier counterparts, thus paralysis is required (and recall results).

Fluid Resuscitation

There are no hard and fast rules for fluid resuscitation, although now most texts will recommend “goal directed therapy” (despite the fact that titrating to urine output, for instance, has never been shown to be advantageous). Other than cost, there is no difference between colloids or crystalloids. Fluid warmers should be used to prevent hypothermia.

Thermal Resuscitation

OR temperature should be warm. Fluid warmers should be used routinely.