The trauma anesthesia/critical care specialist in the field

Field anesthesia may be required on a routine basis in isolated communities in developing countries and from time to time in military conflicts and entrapment situations. The drawover inhalation method is safe, simple, and effective. The equipment is portable and independent of compressed gas supply. Both the Triservice and PAC apparatuses are satisfactory in clinical use. Air enrichment with low flows of oxygen is required in many cases, and intermittent positive pressure should be used in most patients to enhance pulmonary oxygen uptake. Oxygen may be supplied from an oxygen concentrator instead of cylinders. Total intravenous anesthesia is an alternative to the drawover method. Ketamine, midazolam, vecuronium, and fentanyl combine to produce a satisfactory technique using IPPV, but the method requires practice for satisfactory expertise. The technique is of special value in closed-down conditions. Field anesthesia can be practiced safely and effectively but requires special training to acquire familiarity with the techniques. As field anesthesia may be required even in sophisticated countries for entrapment situations, skill should be maintained by practicing the appropriate techniques on a regular basis. Field anesthetic techniques are not second-rate methods--they are just different.