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Anesthesia

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Introduction Battlefield anesthesia primarily describes a state of balanced anesthesia using adequate amounts of anesthetic agents to minimize cardiovascular instability, amnesia, analgesia, and a ... quiescent surgical field in a technologically austere environment. Adapting anesthetic techniques to battlefield conditions requires flexibility and a reliance on fundamental clinical skills. While modern monitors provide a wealth of data, the stethoscope may be the only tool available in an austere environment. Thus, the value of crisp heart sounds and clear breath sounds when caring for an injured service member should not be underestimated. In addition, close collaboration and communication with the surgeon is essential. Airway Many methods for securing a compromised airway exist, depending on the condition of the airway, the comorbid state of the patient, and the environment in which care is being rendered. When a definitive airway is required, it is generally best secured with direct laryngoscopy and an endotracheal tube (ETT), firmly secured in the trachea. Indications for a Definitive Airway Apnea/airway obstruction/hypercarbia. Impending airway obstruction: facial fractures, retropharyngeal hematoma, and inhalation injury. Excessive work of breathing. Shock (bp < 80 mm Hg systolic). Glasgow Coma Scale (GCS) < 8. (See Appendix 2.) Persistent hypoxia (SaO2 < 90%). 9.2 Emergency War Surgery Secondary Airway Compromise Can Result From Failure to recognize the need for an airway. Inability to establish an airway. Failure to recognize an incorrectly placed airway. Displacement of a previously established airway. Failure to recognize the need for ventilation. Induction of General Anesthesia The Anesthesia Provider Must Evaluate the Patient for Concurrent illness and current state of resuscitation. Airway — facial trauma, dentition, hyoid-to-mandibular symphysis length, extent of mouth opening. Cervical spine mobility (preexistent and trauma related). Additional difficult airway indicators. ο Immobilization. ο Children. ο Short neck/receding mandible. ο Prominent upper incisors. Rapid Sequence Intubation Checklist Equipment. ο Laryngoscope, blades, and batteries (tested daily). ο Suction, O2 setup. ο Endotracheal tubes and stylet. ο Alternative tubes (oro, nasopharyngeal, LMA [laryngeal mask airway]). ο IV access items. ο Monitors — pulse ox, ECG, BP, end-tidal CO2. ο Positive pressure ventilation (Ambu bag or anesthesia machine). Drugs. ο Narcotics. ο Muscle relaxants. ο Anxiolytics and amnestics. ο Induction agents and sedatives. ο Inhalation agents. Narcotics. ο Fentanyl, 2.0–2.5 µg/kg IV bolus, then titrate to effect. [Show More]

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