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Blunt and Penetrating Trauma to the Thoracic Aorta

Department of Anesthesiology, Thomas aJefferson University, 111 South 11th Street, Suite 524 Main, Philadelphia, PA 19107

Blunt and penetrating trauma to the thoracic aorta carries a highmortality at the scene of injury. The patients who arrive salvageable to the hospital need rapid diagnosis and treatment of the thoracicvessel injury. Blunt aortic injury is usually due to motor vehicle accidents. Penetrating injuries due to stab wounds or gunshot injury are regionally specific. The cardiac and pulmonary systems are associated with injury to the tho racic aorta in the majority of cases. The use of radiologic stud ies and recently, transesophageal echocardiography, aid in defining the site of injury and if there is accompanying cardiac injury. Large bore intravenous ines, multiple arterial lines, a pulmonary artery catheter to manage fluid replacement, and a double lumen endobronchial tube are needed for anesthetic management. The majority of patients die from exsanguina tion. There isneed while repairing the thoracic aorta, to main tain perfusion to the spinal cord with various methods in order to avoid perioperativeparaplegia. The injuries, diagnostic tests for locating sites of trauma, and perioperative management ap proaches associated with surgical repair are reviewed.

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