title: Operative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity.
abstract: Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects in the setting of hemorrhagic shock. After early resuscitation, trauma patients present a high prevalence of nosocomial pneumonia, which sustains major morbidity. Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory.
authors.affiliation: Service d'anesthésie-réanimation chirurgicale, hôpital Guillaume-et-René-Laennec, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: R
authors.initials: R
authors.lastname: Cinotti
authors.forename: A
authors.initials: A
authors.lastname: Roquilly
authors.forename: P-J
authors.initials: PJ
authors.lastname: Mahé
authors.forename: D
authors.initials: D
authors.lastname: Demeure-Dit-Latte
authors.forename: A-M
authors.initials: AM
authors.lastname: Chupin
authors.forename: N
authors.initials: N
authors.lastname: Josse-Chatel
authors.forename: C
authors.initials: C
authors.lastname: Peneau
authors.forename: J
authors.initials: J
authors.lastname: Paulus
authors.forename: C
authors.initials: C
authors.lastname: Lejus
authors.forename: K
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000758:Anesthesia; D018686:Anesthetics, Intravenous; D005045:Etomidate; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000628:therapy; D007109:Immunity / Q000502:physiology*; D007649:Ketamine / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D010913:Pituitary-Adrenal System / Q000276:immunology / Q000502:physiology / Q000503:physiopathology; D015742:Propofol; D012151:Resuscitation; D012206:Rhabdomyolysis / Q000209:etiology / Q000628:therapy; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000628:therapy; D013514:Surgical Procedures, Operative / Q000379:methods*; D014947:Wounds and Injuries / Q000276:immunology* / Q000601:surgery*
chemical_list: D018686:Anesthetics, Intravenous; D018691:Excitatory Amino Acid Antagonists; D003473:Neuromuscular Nondepolarizing Agents; D007649:Ketamine; D015742:Propofol; D005045:Etomidate
keywords: Anaesthesiology; Anesthésiologie; Choc hémorragique; Cortico-surrenal; Cortico-surrénale; Etomidate; Haemorrhagic shock; Hydrocortisone; Immunity; Immunité; Immunosuppression; Ketamine; Kétamine; Propofol; Resuscitation; Réanimation; Trauma; Étomidate