Do doctors anaesthetise people who are unconscious after an accident before they perform emergency surgery?

Question

I've always wondered if someone who is unconscious after an accident and in need of an immediate operation (such as to relieve pressure on the brain, or fix a punctured lung etc) are given an anaestethic before surgery. If so, how does the anaesthetist ensure that the anaesthetic won't kill someone who's already in a severely weakened state, as I believe they work out the appropriate amount for conscious people based on height and body weight?

Answer 1

It depends on the procedure.

If the patient is in cardiac arrest due to penetrating trauma, then no, we do not anesthetize the patient, because there is no time. The procedure would be a "ED" thoracotomy and involved slicing thought the left chest between the 4th and 5th rib so that we can control bleeding from the descending aorta by "cross clamping".

There are a number of other procedures that can be done with or without (local) anesthesia: tube thoracostomy (chest tube to fix the collapsed lung) and central line placement to name the most common. Again, if we have time, we at least numb the area, but often we don't because the patient is in extremis and there is no time.

If we go to the OR, then yes. The patient is anesthetized with general anesthesia (endotracheal intubation, paralysis, and anesthetics (inhaled and intravenous)). There are risks to anesthesia in these circumstances, but not operating is a much bigger risk.

Anesthesia can cause a cardiac depression which lowers the cardiac output (pulse rate times volume of blood per stoke). But this may not be such a bad thing. Think about it: if you are bleeding, every time your heart beats, more blood is lost. Lowering cardiac output can acutally decrease bleeding. Now, it's not so cut and dry...because lowering cardiac output also means that vital organs (brain, heart, lungs, kidneys, liver) aren't getting the oxygen and nutrients they need.

In the critically injured, the current standard is to do "damage control surgery". This is where we resuscitate the patient with IV fluids and blood during surgery. We surgically correct any bleeding discovered, and if possible, suture or staple off any visceral injury (e.g. perforated colon) - but not fully reconstruct the damage. Active re-warming or maintenance of body temperature is emphasized at this point. The patient is then closed temporarily and put in the ICU where the resuscitation is continued. The idea is to fix the life threatening stuff FAST and get out. Later we take them back and fix the problems on a (hopefully) less ill patient where we can take our time and do it properly.

Other procedures such as craniotomies can also be done under local anethesia. Seen a couple done in the ED with only the neurosurgery resident present. The brain itself does not feel pain.

Answer 2

Yes, we do give anesthesia to trauma victims, but it can be a very difficult task.

When I was training, we called it a "SPOT" (Scopolomine, Pavulon, Oxygen, Tube) of anesthesia - just enough to keep them from moving or remembering anything.

Now it would be versed and pavulon, I guess.

Almost all anesthetics lower blood pressure and decrease the pumping ability of the heart. We have to be very careful to give as much as we can safely give. It's a delicate balance.

One way we do this by placing invasive monitors, so we can see the blood pressure every time the heart beats (arterial line) and look at pressures in the central circulation (central venous pressure monitoring and pulmonary artery catheter monitoring). We can then have a better idea of what the patient's injuries and our anesthetics are doing to the patient.

Many times in these very critical circumstances, the patient is placed on inotropic drips (drugs that make the heart squeeze stronger) or vasoconstrictors (drugs that make the blood vessels constrict, thereby increasing blood pressure)

There's a lot more to the administration of anesthesia than height and weight. That's why it takes a lot of years to learn to do it right!

Answer 3

When someone arrives unconscious needing major surgery, if the anesthesiologist agrees that the benefits outweigh the risks, the operation will take place. Usually, the patient is intubated, paralyzed with neuromuscular blockers, artificially ventilated. Vital signs are monitored and when appropriate anesthetics are administered carefully to prevent further loss of blood pressure. Usually, in these cases, the person is unconscious from low blood pressure, having lost a significant percentage of their blood volume. Fluid replacement usually starts at the scene but is continued throughout the operation. Blood replacement, colloids, clotting factors, plasma, and fluids are adminstered when appropriate to maintain perfusion of all organs until the surgery is over and hemostasis is atttained.

Answer 4

you're correct that it's very easy to kill someone during the course of administering an anesthetic to someone who's critically ill. most prudent anesthesiologists would reduce the dose of drugs used to induce anesthesia to avoid cardiovascular collapse. but the simple answer is that we do in fact provide anesthesia in those cases because someone who's unconscious can still respond to surgical stimulus by moving. the withdrawl from noxious stimulus reflex remains intact, just as if you were to tap that unconscious patient's knee, you would be able to elicit a knee jerk reflex. so even though the patient may not remember anything, we still need to maintain good operating conditions for the surgeon- so yes, you gotta give 'em an anesthetic.

Answer 5

Anethesia is necessary to keep the patient out of pain and relaxed for the surgery. In the case of emergency surgery, the surgical staff would include an anesthetist who would monitor the patient and decide if it was necessary to apply anesthesia.

Answer 6

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Answer 7

Set your pc alarm to ring hourly—stand up for 1 to 5 minutes each time it goes off.

Answer 8

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Answer 9

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Answer 10

Deeply unconscious people ie those who don`t respond to even very painful srimuli are not operated upon. Unconsciousness is graded 1 to 5.
Anestesiologist or emergency physician evaluates the patient frequently till consciousness is regained only then surgery is planned.
Unconscious man is not fit for surgery under general anesthesia