Anaesthesia under civil war conditions. An account of missions with British Red Cross surgical teams in Cambodia and Angola

MILITANCY TRAUMA : ANAESTHESIA AND CRITICAL CARE MANAGEMENT

At a Base Hospital, 2151 patients of militancy trauma were managed from Jan 1990 to 31 May 1993. It involved military, paramilitary, ex-servicemen, civilians, foreigners and antinational elements. The nature of trauma was either gun shot wounds (1333) or blast injuries (818). Polytrauma (multiple injury to soft tissue, hone, parenchyma with shock or injury to more than one body region) was seen in 862 patients. Standard protocol was evolved for initial management in ICU/acute surgical ward. Time taken for initial evaluation of injury, resuscitation, respiratory care and oxygen therapy, analgesics, blood group cross matching, antibiotics and preparation of the part before surgery was usually 45 min. Anaesthesia was induced with ketamine 2 mg/kg or thiopentone 3 mg/kg based on haemodynaemic response and maintained with N₂O : O₂ (50 : 50 ratio), relaxant controlled ventilation. Mortality was 3.8% including 4 deaths on operation table.

The Role of Regional Anesthesia under Field Conditions

The authors, who served as anesthesiologists for 15 months at an International Committee of the Red Cross (ICRC) surgical field hospital in a Cambodian refugee camp, report their anesthesiologic experience with 2,906 patients. In spite of preferential use of regional anesthetic techniques, general anesthesia was required in 68% of the cases. Local infiltration anesthesia was applied in 21% of the cases, conduction anesthesia in 3%, and spinal anesthesia in 8%.

Anesthesia under field conditions. A review of 945 cases

In 1980, two German Red Cross surgical teams served for 6 months at a field hospital in the Kampuchean Refugee Camp Khao I Dang in Thailand. The responsibilities of the two participating anesthesiologists, whose experience is reported in the present study, included anesthetic administration, resuscitation, triage, postoperative intensive care as well as consultations in nonsurgical emergencies and teaching programs. 40% of the 945 emergency operations were battle casualties. Since many patients were in poor condition before surgery, maintenance or restoration of vital functions was of prime importance, particularly shock therapy. Although local or regional anesthesia was preferred, general anesthesia was necessary in 568 cases (60%), with endotracheal intubation in 336 of these cases. Ketamine, generally combined with diazepam or flunitrazepam, proved advantageous for spontaneous respiration, assisted ventilation, and endotracheal anesthesia. Although the conditions were primitive, no fatal anesthetic complications were observed (surgical mortality rate, less than 2%).