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  • Title: [Anesthetic management for emergency operation in seven patients with gunshot injury].
    Author: Takauchi Y, Abe K, Demizu A.
    Journal: Masui; 1994 Jan; 43(1):111-5. PubMed ID: 8309042.
    Abstract:
    Seven patients with gunshot injury underwent emergency operations under general anesthesia. Trachea was intubated without muscle relaxants or after crash induction. Anesthesia was maintained with intravenous or volatile anesthetic agents titrated slowly. Four of seven patients fell into hypovolemic shock and were treated with aggressive intravenous volume replacement, vasopressors and catecholamines. Seven patients were given blood transfusion, of which the largest amount given was 17700 ml during the operation. Hemopneumothorax occurred in four patients, who needed intrathoracic drainage. Six patients survived and one died of multiple organ failure secondary to hypovolemic shock. The nature and severity of a bullet wound depend on the characteristics of the bullet (mass, construction, tendency to fragment or yaw, and velocity) and the tissue through which it has traveled. Therefore, the wound is often larger than expected, and the bullet may travel in an unexpected direction. Thus, it is important in anesthetic management of a patient with gunshot injury, to understand its mechanisms and evaluate the wound and to treat the patients in the same way as with other multiple trauma, especially taking care of hypovolemic shock.
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