Objectives

1. Review the anesthetic management of abdominal trauma, including considerations for resuscitation, preoperative preparation, intraoperative management, and acute postoperative care.

2. Discuss the anesthetic and surgical implications of specific abdominal organ injuries.

3. Describe the principles of nonoperative management of abdominal trauma.

INTRODUCTION

The abdomen is frequently injured following trauma, is a major site for posttraumatic bleeding, and is difficult to evaluate and monitor clinically. Furthermore, uncontrolled hemorrhage is the major acute cause of death immediately following abdominal trauma; [1] therefore, patients often present to the operating room for exploratory laparotomy following acute abdominal trauma.

The abdomen is aptly named, having been derived from the Latin terms abdere, “to hide,” and the termination – omen, which may be a contraction of omentum or omen in the sense of presage (insight was said to be gained by the ancients during inspection of the abdominal contents). The term first appeared in the English literature in 1541 in a translation of Galen's “Terapeutyke,” as l'abdomen [2].

This chapter describes the anesthetic management of abdominal trauma including the resuscitation considerations, preoperative preparation, intraoperative management, and acute postoperative care.

ANATOMIC CONSIDERATIONS

The mechanism of injury and wound location assists the clinician in predicting the organs injured, magnitude of blood loss, and the expected scope of surgery. The abdomen can be divided into four anatomic compartments (Table 10.1); thoracic, peritoneal (true abdomen), retroperitoneal, and pelvic spaces. Clinical evaluation of these spaces is difficult by physical examination alone, especially in the acute trauma patient.