Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases

Abstract

BackgroundMilitary anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.ObjectiveThis study aimed to describe and analyze French anesthetic activity in a deployed military setting.MethodsBetween October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital.ResultsDuring the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations.ConclusionIn the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.

Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study

“…In a separate study, app data provided a proxy for surgical case volumes, and could therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity [ 13 ]. In the literature, the largest studies describing anesthesia practice including regional techniques in LMIC are a large cohort study describing Médecins Sans Frontières activity during a 6-year period and a register study analyzing French anesthetic activity in a deployed military setting [ 2 , 5 ]. However, both these studies describe transplanted (practitioners from mostly HIC working in low-resourced settings) and not local practice patterns.…”

“…A shortage of resources such as monitors, oxygen or personnel emphasize the importance of the availability of regional anesthesia techniques in austere settings [ 5 , 23 ]. This is reflected in the first World Federation of Societies of Anesthesiologists sponsored East African regional anesthesia and acute pain medicine fellowship.…”

“…Regional anesthesia can both reduce perioperative morbidity and improve the availability of safe anesthesia in austere settings [ 2 ]. Advantages include excellent operating conditions, profound analgesia without sedation, stable hemodynamics, reduced need for other anesthetics and oxygen, and rapid recovery [ 3 – 5 ]. Forgoing general anesthesia confers indirect benefits, such as avoidance of airway manipulation and the side effects of anesthetic drugs, which may favorably impact the allocation of resources during postanesthesia recovery.…”