Anesthesia in northern Iraq: an audit from a field hospital

A Royal Naval field surgical team deployed to Iraq for 6 weeks. Seventy-one anesthetics were administered to 52 patients. The Triservice anesthetic apparatus (TSA) was used with controlled ventilation and either halothane plus trichloroethylene or isoflurane. Other techniques included spontaneous ventilation via the TSA, ketamine and midazolam, either with or without controlled ventilation, or local anesthesia. A simple modification allowed preoxygenation with 100% oxygen. Controlled ventilation with air alone was usually associated with satisfactory pulse oximetry and oxygen economy. Isoflurane was not significantly hypotensive and recovery was more rapid than with halothane/trichloroethylene. Drawover techniques with controlled ventilation were satisfactory for children as small as 6.5 kg. Overnight ventilation was instituted on three occasions, and it was found that a simple positive end expiratory pressure system could be applied to the Laerdal valve. Pulse oximetry, ECG, and automatic arterial pressure monitoring facilities were used. The total drug expenditure for all 71 anesthetics was only $178.