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Anaesthesia Considerations in Penetrating Trauma

All patients were admitted to the intensive care unit (ICU). The goals of postoperative care were normothermia, a mean arterial pressure up to 65 mm Hg, a hematocrit of greater than 27%, urine output up to 1 to 1.5 mL/kg per hour, and appropriate analgesia and anxiety treatment. Most patients were weaned from mechanical ventilation after a median of 1 day. Six patients were hemodynamically stable. Most patients had postoperative severe graft edema. Preventive anticoagulation was provided with lowmolecular-weight heparin. As soon as bowel sounds reappeared, enteral feeding with high-protein formulas was started, usually on postoperative day 1. Immunosuppression was continued postoperatively. Two patients had acute cellular rejection in the ICU. Most patients had opportunistic infections, with bacterial infections predominating. One patient with multiresistant Pseudomonas aeruginosa infection that affected his face and left hand allograft had cardiac arrest on day 33 and died on day 65. The average length of ICU stay was 17.4 days, with a range of 4 to 65 days. Opportunistic bacterial infections were a remarkable feature during the postoperative period for all the patients.