| Key strategies in trauma anesthesia for severe hemorrhage: a narrative review |
Byung Hee Kang1,2 
, Hye-Min Sohn2,3
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1Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
2Gyeonggi Southern Regional Trauma Center, Ajou University Hospital, Suwon, Korea
3Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea |
Corresponding author:
Hye-Min Sohn, Tel: +82-31-219-7521, Fax: +82-31-219-5579,
Email: sfsohn@aumc.ac.kr
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Received: 19 August 2025 • Revised: 24 September 2025 • Accepted: 30 September 2025 |
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| Abstract |
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Trauma anesthesia demands a high level of expertise. In this context, anesthesiologists are required to manage complex physiology and rapidly evolving scenarios in critically injured patients, who often present profound hemodynamic instability. In addition to providing intraoperative anesthesia, trauma anesthesiologists serve as active resuscitationists and are key players in the trauma team from the moment of the patient’s arrival. General trauma resuscitation follows the ABCDE approach. The key areas of trauma anesthesia include airway management (A, airway), with rapid sequence induction and strategies for handling difficult airways; ventilation techniques (B, breathing) aimed at protecting the traumatized lungs under pressure; and hemodynamic resuscitation (C, circulation), which incorporates permissive hypotension, implementing massive transfusion protocols, and managing trauma-induced coagulopathy. Neuromonitoring and brain protection (D, disability) are crucial in cases of traumatic brain and spinal cord injuries, requiring precise blood pressure control and intracranial pressure monitoring. Advanced monitoring techniques (E, exposure), which include point-of-care ultrasound and invasive hemodynamic assessment, further enhance intraoperative decision-making. Above all, effective trauma anesthesia hinges on seamless interdisciplinary collaboration (F, force), with decision-making shared between anesthesiologists and trauma surgeons in high-risk surgeries. In this review, we highlight the pivotal role of trauma anesthesiologists in severe hemorrhage management, one of the most critical challenges in trauma resuscitation, and emphasize that an integrated, proactive approach is essential not only for improving immediate survival, but also for optimizing long-term recovery of the patient. |
| Key Words:
Airway management; Anesthesia, General; Blood coagulation disorders; Blood transfusion; Hemodynamic monitoring; Hemorrhage; Hypotension; Resuscitation |
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