The anesthetic management of cardiovascular trauma.
OBJECTIVE
Although little new has been specifically written in recent years regarding the anesthesia management of cardiovascular trauma, two specific areas have seen recent interest and progress, namely the endovascular management of blunt thoracic aortic trauma and commotio cordis, or sudden death following blunt precordial injury.


RESULTS
Endovascular repair of thoracic aortic injury has been shown in multiple studies to have short to medium-term mortality and morbidity advantages over repair via thoracotomy. However, long-term (many years) outcome and the expenses required for long-term follow-up of endovascular repairs remain unknown. The risk of commotio cordis during sports activities has become more known to the general population. Recent studies have indicated a very specific limited time during the upstroke of the T-wave to be the critical time for injury, but specific channel involvement is unclear.


CONCLUSIONS
Although transesophageal echocardiography diagnosis of aortic trauma is very sensitive and specific, in general, the lack of immediate availability at all times of skilled echocardiographers and the immediate availability of spiral computed tomography scanners in trauma centers limits the use of transesophageal echocardiography as a first-line diagnostic tool. Endovascular repair of traumatic aortic injury is becoming routine. Commotio cordis is being increasingly recognized as a cause of acute post-traumatic sudden death.
Singh
Karen E
KE
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia 22901, USA.
Baum
Victor C
VC
D000758:Anesthesia / Q000379:methods*; D001013:Aorta, Thoracic / Q000293:injuries*; D003331:Coronary Vessels / Q000293:injuries*; D017548:Echocardiography, Transesophageal; D006335:Heart Injuries / Q000601:surgery*; D006801:Humans; D010496:Pericardium / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery