Anesthesia for orthopedic trauma
- Kayser Enneking, MD
Kayser Enneking, MD
- Professor of Anesthesiology and Orthopaedics and Rehabilitation
- University of Florida College of Medicine
- Linda Le-Wendling, MD
Linda Le-Wendling, MD
- Associate Professor of Anesthesiology
- Fellowship Director, Division of Acute and Perioperative Pain Medicine
- University of Florida, College of Medicine
- Barys Ihnatsenka, MD
Barys Ihnatsenka, MD
- Assistant Professor of Anesthesiology
- University of Florida
Traumatic orthopedic injuries can range in severity from isolated wounds to complex injuries involving multiple organ systems. Patients with orthopedic injury may require anesthesia for emergency repair or damage control surgery, or for semielective procedures after evaluation and stabilization.
This topic will discuss the general approach to anesthesia for adult patients with orthopedic injuries, anesthesia for specific categories of orthopedic injury, and options for both regional and general anesthesia for these cases. Initial management of trauma in adults, damage control surgery and resuscitation, anesthesia for patients with spinal cord injury, and management of the difficult airway are discussed separately. (See "Initial management of trauma in adults" and "Anesthesia for adults with acute spinal cord injury" and "Management of the difficult airway for general anesthesia" and "Severe pelvic fracture in the adult trauma patient" and "Surgical management of severe extremity injury" and "Anesthesia for patients with acute traumatic brain injury".)
Preanesthesia evaluation of patients with orthopedic trauma should be as thorough as the urgency of the situation allows. Initial assessment should be guided by advanced trauma life support (ATLS) protocols. (See "Initial management of trauma in adults", section on 'Primary evaluation and management'.)
When possible, the full extent of the patient's injuries, course since injury, medical history, allergies, medications, and last oral intake should be reviewed. An airway assessment and directed physical examination should be performed. The patient may be unable to provide an accurate medical history because of head trauma, alcohol or illicit drug use, dementia, or severe pain.
Results of laboratory testing should be reviewed, including electrolytes, glucose, hemoglobin, platelet count, coagulation parameters, and lactate. Hemoglobin may be normal in patients who are hypovolemic, and may drop as the patient is resuscitated.
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- PREOPERATIVE EVALUATION
- TIMING OF SURGERY
- SURGICAL COORDINATION
- CHOICE OF ANESTHETIC TECHNIQUE
- ANESTHESIA FOR UPPER EXTREMITY TRAUMA
- Proximal upper extremity fractures
- Midhumerus fracture
- Elbow fracture
- Fracture distal to the elbow
- ANESTHESIA FOR LOWER EXTREMITY TRAUMA
- Hip fracture
- - Choice of anesthetic technique for hip fracture
- - General anesthesia
- - Neuraxial anesthesia
- Spinal anesthesia
- Epidural anesthesia
- Combined spinal–epidural
- - Peripheral nerve block
- - Monitoring
- - Positioning
- Midshaft and distal femur fracture
- Knee and lower leg fracture
- Ankle and foot fractures
- PELVIC FRACTURE
- FAT EMBOLISM
- SUMMARY AND RECOMMENDATIONS