Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XV: Anesthesia and Analgesia
United States Department of Defense
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Hospitals dedicated to advanced resuscitation and surgical care must anticipate the sequelae of trauma, anesthesia, and operation. As a result of thoracic trauma, the likelihood of overhydration, or surgical manipulation, many of these patients will be unable to breathe adequately and will require mechanical ventilatory support. Ventilators used for these applications should be volumecycled machines capable of delivering inspired oxygen concentrations up to 100% and of providing positive end-expiratory pressures. Ideally, they should have the same alarms, adjustments, and options (such as intermittent mandatory ventilation) as ventilators in current critical care applications.
Narcotics and analgesics must be judiciously managed in the postoperative surgical patient. Small doses administered intravenously are usually most effective in the immediate recovery period. Changes in position and the adjustment of pads, braces, pillows, etc., may do much to make the patient comfortable and decrease the need for pharmacological intervention. The use of regional blocks should provide effective analgesia while avoiding depressant medications. It must be borne in mind that restlessness and agitation may be signs of hypoxia rather than true pain.
Anesthetic techniques using short-acting narcotics, hypnotics, and muscle relaxants may reduce recovery room problems, but it still may be necessary to reverse narcotics or use additional muscle relaxant reversal drugs. It is equally important to be sure that each recovery site offers the safety of an oxygen supply in the event that a patient must be ventilated, as well as effective suction apparatus. Wherever logistically possible, the ability to measure blood gases should be available. Measurement of arterial or central venous oxygen tension gives the physician a working knowledge not only of lung function but also of metabolism, cardiovascular stability, and effectiveness of resuscitation. The addition of trained and experienced specialists in critical care medicine to forward medical facilities will enhance the quality of care provided and will free anesthesia personnel to concentrate their efforts in the operating rooms.
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