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14 - Anesthesia for Spinal Cord Trauma
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- By M. Sean Kincaid, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, Arthur M. Lam, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
- Edited by Charles E. Smith, Case Western Reserve University, Ohio
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- Book:
- Trauma Anesthesia
- Published online:
- 18 January 2010
- Print publication:
- 23 June 2008, pp 213-224
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- Chapter
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Summary
Objectives
Review the prevalence and types of spinal cord injuries.
Evaluate airway management choices in patients with spinal cord injuries.
Review the implications of spinal cord injuries on intraoperative anesthetic management.
Discuss the anesthetic implications of neuromonitoring in patients with spinal cord injuries.
Spinal cord injury (SCI) is a common traumatic injury that often requires hospitalization and surgical intervention. As a result, the anesthesiologist encounters many patients with SCI at various stages of their hospitalization, both in and out of the operating room. There are several aspects of their care, including airway management, initial resuscitation, and intraoperative management, that require a particular understanding of their disease and for which the anesthesiologist is particularly suited.
PREVALENCE AND ETIOLOGY OF SPINAL CORD INJURY
Spinal column injury encompasses a wide range of pathologies, from the minor to the life-threatening. The bony structure of the spine encloses, protects, and supports the spinal cord. Injury may occur anywhere from the articulation of the cervical spine with occiput to the sacrum. It may include fractures of the bone or ligamentous injury, and it may or may not have underlying cord damage, the presence of which would define SCI. Insult to the cord comprises a spectrum of disease depending on the location of the injury and the nature of the deficit (see Chapter 13).
A population-based study evaluating spinal column injury in a Canadian community demonstrated less than a 6 percent incidence of neurologic injury in persons who sustain a spinal column fracture [1].
11 - Head Trauma – Anesthesia Considerations and Management
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- By Paul Tenenbein, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, M. Sean Kincaid, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, Arthur M. Lam, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
- Edited by Charles E. Smith, Case Western Reserve University, Ohio
-
- Book:
- Trauma Anesthesia
- Published online:
- 18 January 2010
- Print publication:
- 23 June 2008, pp 172-186
-
- Chapter
- Export citation
-
Summary
Objectives
Review the pathophysiology of traumatic brain injury.
Summarize the systemic manifestations of acute traumatic brain injury.
Review the current guidelines regarding management of traumatic brain injury.
Discuss the anesthetic management of traumatic brain injury and the potential complications.
INTRODUCTION
Traumatic brain injury (TBI) imposes a significant burden on society, the presence of which is the primary determinant in quality of outcome following trauma [1]. With respect to age, it occurs in a bimodal fashion. Young persons between 15 and 24 years suffer head injuries in motor vehicles and violence, especially in association with alcohol use. Older persons, particularly those older than 75 years, suffer from an increased frequency of falls leading to head injury. It is estimated that 1.6 million head injuries occur annually in the United States with 250,000 patients requiring hospitalization [2, 3]. The results of these injuries include 60,000 deaths and 70,000–90,000 permanent neurologic disabilities [2, 4]. It is estimated that $100 billion is spent annually in the United States alone providing care for these individuals. Primary prevention is essential to decrease the burden of this problem. But for those who do sustain TBI, there is much we can do to provide the best possible care for these patients. Although the Brain Trauma Foundation has provided guidelines for the management of severe traumatic brain injury (www.braintrauma.org), there are still many institutional differences in the care these patients receive, potentially affecting outcome [5].