ABSTRACT
Resumen: El manejo anestésico afecta directamente en la evolución del paciente durante la resucitación dentro del quirófano, influenciando directamente en la mortalidad y morbilidad. Se ha demostrado que recibir atención en centros hospitalarios de trauma nivel I disminuye el riesgo de muerte en pacientes lesionados en un 25% comparado con un centro no traumatológico. El presente trabajo presenta una lista de verificación para el paciente con trauma y cirugía de urgencia, en un intento de ayudar al anestesiólogo y al equipo quirúrgico a no olvidar pasos esenciales en momentos de estrés, adaptándose a cada centro hospitalario de acuerdo con protocolos y recursos propios de cada institución, ya que son, evidentemente, recomendaciones basadas en prevenir la conocida y temida tríada de la muerte, así como las múltiples complicaciones tardías, que se pudieran presentar.
Abstract: Anesthetic management directly affects the evolution of the patient during resuscitation within the operating room, directly influencing mortality and morbidity. It has been shown that receiving hospital care in trauma level I reduces the risk of death in injured patients by 25% compared to a non-traumatological center. The present work presents a checklist for the patient with trauma and emergency surgery, in an attempt to help the anesthesiologist and the surgical team not to forget essential steps in times of stress, adapting to each hospital according to protocols and resources own of each institution, since they are, evidently, recommendations based on preventing the well-known and feared triad of death, as well as the multiple late complications, that could arise.
ABSTRACT
Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.