Robinson G J
Aust Fam Physician. 1977 Apr;6(4):313-7.
Emergencies resulting in death of the patient are sufficient reason for insisting on only medically qualified people giving anaesthetics. Unlike in most other specialities, complications in anaesthesia usually will not await the arrival of the expert. Trauma provides the anaesthetist with some of his most testing occasions. Most problems are related, as with emergencies, to basic derangements of respiratory and circulatory physiology However, there is a steady progression with severe trauma cases that is not a common feature of the ordinary anaesthetic disaster. Respiratory problems are either of obstructive origin or due to failure to generate respiratory muscle activity. Circulatory problems, in the vast majority of cases, consist of low cardiac output because of relatively deficient circulatory blood volume. Overload of the circulation resulting in acute pulmonary oedema is often feared but uncommonly seen. Another cause of failure of output of the heart lies in the heart itself, either because heart muscle is not contracting well enough--myocardial failure, or because of disorder of rhythm.
导致患者死亡的紧急情况是坚持只有具备医学资质的人员才能实施麻醉的充分理由。与大多数其他专科不同，麻醉并发症通常不会等到专家到来才出现。创伤为麻醉医生提供了一些最具挑战性的情况。与紧急情况一样，大多数问题都与呼吸和循环生理的基本紊乱有关。然而，严重创伤病例有一个稳定的进展过程，这并非普通麻醉灾难的常见特征。呼吸问题要么源于阻塞，要么是由于呼吸肌活动无法产生。在绝大多数情况下，循环问题是由于循环血容量相对不足导致的心输出量降低。人们常常担心循环过载会导致急性肺水肿，但这种情况并不常见。心脏输出失败的另一个原因在于心脏本身，要么是因为心肌收缩不够好——心肌衰竭，要么是因为节律紊乱。
