Essentials of Trauma Anesthesia and Intensive Care

The glory of medicine is that it constantly moves forward; there is always more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort—William James Mayo. In keeping with the lines of Mayo, we bring the readers a publication that is the first of its kind, offering a comprehensive overview of managing trauma patients through data and studies. This book is a humble effort to bring forth extensive insight and knowhow on managing trauma patients both perioperatively and in the intensive care unit.

The burden of trauma is exponentially increasing around the world—even more so in India. Appropriate and timely management is critical to a positive outcome, warranting a sound approach and a solid understanding of the pathophysiology of trauma patients. The ATLS® principles help protocolize the
management of the emergency department; however, there is inadequate literature on trauma patient management in the operating room and thereafter in the intensive care unit. Anesthesiologists are often involved in the overall care of trauma patients in the emergency department, OR, and the ICU; therefore,
they need continuing education to enhance their knowledge and skills. The contents of this book were chosen to address the lacunae in the knowledge and management of trauma patients and to keep physicians and anesthesiologists updated on the state of the art. Special emphasis have been given to topics such as airway management, head trauma, and thoracic and spine injury. One neglected, yet important, topic—brain death and subsequent organ donation—is discussed in detail.

The inspiration for this book was the lack of a textbook that succinctly addresses this critical subject, especially in the Indian sub-continent. A bleeding polytrauma patient, in extremis, may initially appear to be a gruesome, non-salvageable case, prompting anesthesiologists to prematurely terminate resuscitative efforts. However, if appropriately managed during the initial phases, not only with correct scientific knowledge but also with empathy and compassion, a young, healthy, productive life can be saved, thus giving a feeling of gratification.

No words can adequately express my gratitude toward Prof MC Misra, Director, All India Institute of Medical Sciences and Chief, JPN Apex Trauma Center. He has been a constant inspiration not only to me but to the entire medical fraternity as we work toward a common cause—providing high quality care to trauma patients. My sincere thanks go to Prof MK Arora for his invaluable support and guidance. It would have been difficult to write and finish this book without the moral support and positive attitude of my beloved teacher, Dr Bharati Tendolkar, who is a mother figure and constant inspiration for me. This book would not have been possible without the efforts, feedback, and suggestions of all co-authors, whose inputs provided a huge impetus for the project. The work of my dear colleagues and the staff at JPN Apex Trauma Center was always of the highest standards, whether it was providing photos, X-rays, or CT images. I owe gratitude to the technical staff of OT assistants and hospital attendants for their unconditional support. I am also obliged to Shri Narayanji, Anil Bhat and Lakhan for volunteering to complete photography and other jobs in the OR. My special thanks to Ms Pallavi Tiwari, who helped me throughout the editing process.

I am sure this book will provide knowledge and translate into a better understanding of the effective management of trauma patients in the OR and the intensive care unit.