Volume 15: 2010-2011 Issue 01, March 2013

Pakistan Society of Anaesthesiologists Inside this Issue: Karachi - 2012-2013 · Editor's Note · Choice of fluid therapy in trauma patients Patron · in trauma Prof. S. Tipu Sultan · Trauma and the Anaesthetist President · Summary of guidelines - Association of Anaesthetists of Great Britain and Ireland (AAGBI) Dr. Madiha Hashmi · 10th SAARC-AA Conference Dhaka, Bangladesh pictures

President Elect Dr. Zia Akhtar EDITOR'S NOTE Trauma is the leading cause of death worldwide. Haemorrhagic shock accounts for 80% of deaths in Gen. Secretary the operating theatre and up to 50% of deaths in the first 24 h after . Dr. Amin Khawaja With the increasing incidents of terrorist activities the number of injured in Pakistan and especially in Joint Secretary Karachi have increased significantly over the last few years. Therefore it is imperative that hospitals, Dr Hamid ? not only teaching but even smaller and private sector hospitals develop protocols directed at improving management of massive haemorrhage in trauma patients. Treasurer Dr Nabeela Rafiq Anaesthesiologists are an integral part of the trauma teams and should take the initiative to better understand the priorities in specific situations and develop an effective teamwork and communication Executive Members essential for the success of trauma . Dr. A Waheed Khan Prof Fauzia A Khan Dr Madiha Hashmi Dr. Akhtar Aziz Khan Editor, PSA News Letter Prof Saeeda Haider Prof Younis Khatri Dr. Salamat Kamal CHOICE OF FLUID THERAPY IN TRAUMA PATIENTS Dr. RehanaYasin Dr. Shahid Amin The primary goal of resuscitation in patients coming with trauma is to restore circulating plasma Prof Sadqa Aftab volume, identify the source of hemorrhage and control it as rapidly as possible. The “ideal” fluid Dr. Gauhar Afshan replacement regimen in trauma patients is still controversial. Aside from , several non-blood Dr. Nighat Abbas alternativesincluding crystalloids, hypertonic solutions, albumin, and non-protein (synthetic) Dr. Aliya Ahmed colloidsare available to correct hypovolaemia in trauma patient. Dr. M Amin Suleman Dr. Zia Akhter The composition of fluid administered to the actively haemorrhaging patient is as important as the Dr. NajmaSaiyed rate and quantity. While isotonic crystalloid solutions are important for making up 'third space' losses, Dr. RoohinaNausheenBaloch and are inexpensive and readily available, they do not adequately replace the whole blood that the Dr. Samina Ismail patient is losing, also the intravascular persistence of these solutions is low, with estimates of as little Dr. NaheedArjumand as 12% of an administered bolus of 0.9% saline remaining in the circulation 30 minutes later. Dr. Muzammil Hussain Colloidal solutions, such as hypertonic saline and dextran, have been recommended for early Dr. M NadeemMuneer resuscitation; however, so far, there has been no definitive evidence of benefit. Dr. M Hamid Early transfusion therapy with red cells, plasma and platelets is thus essential to successful Dr. Serajuddin resuscitation. While in the long term blood transfusion has been associated with an increased Dr. NazirJatoi incidence of organ system failure and death as well as profound immune suppression. Early replacement of oxygen-carrying capacity, in the form of red blood cells, may be life-saving. Newsletter: Editor Early transfusion of plasma and platelets is similarly advantageous, as complicating Dr. Madiha Hashmi haemorrhagic shock is easier to prevent than to reverse. For the patient who requires a transfusion of >1 blood volume (approximately 10 units of red blood cells) in a short period, dilutional coagulopathy Newsletter Committee is almost certain and in that situation packed red cell, plasma and platelet concentrates - 1