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%).