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சுருக்கம்

Alcohol Intoxicated Trauma Patients: Hemodynamic Effects of General Anesthesia

Jennifer Mardini, Deep Patel, Maegan Tupinio, Kevin Nolt, Steven Allen, Arne Budde

Purpose: The current work aims to determine whether patients presenting with Acute Alcohol Intoxicated (AAI) traumatic injuries are at higher risk for hemodynamic compromise after induction of general anesthesia.

Method: A retrospective chart review from January 1, 2008 to June 1, 2017 of patients aged ≥ 18 years of age undergoing emergent exploratory laparotomy within 4 hours of presentation were included in the study. Data collected included age, sex, weight, blood alcohol level, Systolic Blood Pressure (SBP), INR, injury severity score, base deficit, pre- and post-induction Mean Arterial Pressure (MAP), induction medication and dose, length of hypotension, and vasoactive medications administered within 20 minutes post-induction.

Results: Post-induction MAPs were lower for alcohol intoxicated patients than for non-intoxicated controls (p=0.018) despite both groups having similar admission SBP (0.295) and pre-induction MAPs (0.171). Alcohol intoxicated patients also have significant longer duration of hypotension following induction (p=0.016), however there was no significant difference in the requirement of vasopressor use within twenty minutes post-induction (p=0.279).

Conclusion: Our findings (lower MAPs and longer duration of hypotension than controls following induction of general anesthesia, as well as blood chemistry suggestive of volume contraction) support the notion of alcoholinduced hemodynamic dysregulation in intoxicated trauma patients with presumed intra-abdominal injury. Based on these results, it is essential for the anesthesiologist to be prepared to support blood pressures in order to maintain adequate perfusion in acutely intoxicated patients requiring general anesthesia.