[Anesthesiologic problems and specifics in the management of severe pelvic injuries]

There is a close relationship between trauma of the pelvis, hemorrhagic shock, microcirculation disturbances and multiple organ failure. Of primary importance are the treatment of pain, early intubation, artificial ventilation, protection against heat loss and replacement of massive blood loss. Contrary to conventional volume replacement by electrolyte solutions, the author favors the administration of colloids, especially the new concept of "small volume resuscitation," i.e., the rapid infusion of a mixture of hypertonic saline solution and hyperoncotic dextran. Although there are limitations, the central venous and pulmonary arterial pressure reflect the volume balance of the circulation. The oxygen partial pressure of mixed venous blood, more or less reflecting the global oxygen supply state of the organism, can be measured only by means of a pulmonary artery catheter. The outcome depends greatly on optimization of the oxygen supply to a patient in shock whose oxygen needs are remarkably increased. Therapy should be aimed at keeping the arterial oxygen tension above 150 mmHg, increasing the cardiac index to 50% above normal, and stabilizing the hemoglobin concentration at an individually optimized value.