General anesthesia: management considerations in the trauma patient

Endotracheal intubation and mechanical ventilation are vital components of the resuscitation of the most seriously injured patients and those suffering from multisystem trauma. Therefore, general anesthesia administered both intravenously and endotracheally becomes the anesthetic of choice for most of this patient population. Endotracheal intubation and anesthetic induction techniques are designed to protect the patient's cervical spinal cord from injury and his or her airway from aspiration of gastric contents. Anesthetic drugs are chosen to minimize cardiovascular depression, to maximize oxygen delivery to the tissues, and to decrease intracranial pressure. Monitoring techniques include the basic noninvasive monitoring set forth in the American Society of Anesthesiologist's standards, as well as invasive cardiac monitoring via arterial catheters and pulmonary artery catheters. Attention to detail in the recovery room will continue the success of a well-conducted general anesthetic for the trauma patient.