Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XV: Anesthesia and Analgesia
Anesthesia Equipment
United States Department of Defense
The demonstrated capability for more rapid evacuation of seriously wounded casualties from the battle area has resulted in an increase in the complexity of surgery performed at installations in the combat zone. These changes have mandated a similar complexity of anesthesia equipment and techniques. Without the appropriate equipment, management of the seriously injured patient is impossible for even the most competent anesthetist.
Anesthesia equipment in a forward installation should include standard apparatus for administration of inhalation, intravenous, and regional anesthetics, as well as for oxygen supplementation and ventilatory support. An austere environment imposed by the tactical situation or geographical location may demand innovative approaches to what are normally routine clinical problems. For example, the scarcity of medical-grade compressed gas may require the anesthetist to use draw-over vaporizers, intermittent flow machines, or other techniques not in common practice in the U.S. There are many examples in the literature of improvised equipment and techniques that have served well in such difficult situations.
Complete airway equipment, including apparatus designed for pediatric use, should be readily available. An adequate suction, a defibrillator, and appropriate resuscitation drugs are required in any anesthetizing location. This is equally important regardless of whether general or regional technique is planned. It is also prudent to have a large-bore intravenous cannula or similar device handy to establish an emergency airway by cricothyroid puncture in the event of total upper airway obstruction. It should be kept in mind that ventilators are essential components of anesthesia delivery systems so that anesthesia personnel can resuscitate during surgical procedures. Experience has shown that the anesthetist must be prepared to treat local civilian casualties, sometimes including substantial numbers of children and neonates.
Appropriate adapters and delivery systems, such as nonrebreathing circuits and pediatric circle systems, are essential for proper anesthetic management.
In medical facilities dedicated to definitive care, anesthesia equipment should be as close to state-of-theart as time and the local situation permit. Once this sophisticated equipment is in place, it must be checked and calibrated on a routine basis to assure its safety. Support personnel with mechanical knowledge of anesthesia equipment, its calibration, and its maintenance will be vital to safe application of care Replacement units and spare parts should be in the theater supply system.