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Chapter 56. Regional Anesthesia in Austere Environment Medicine

Peripheral nerve blocks (PNBs) are well suited for anesthesia in austere environments over general anesthesia because:

A. They allow optimal use of scarce resources.

B. Equipment for PNBs is always available in developing countries.

C. Routine monitoring is not required during PNB procedures.

D. PNBs administered outside the operating room do not require the availability of airway equipment.

A is correct. Whenever possible, regional anesthesia is the preferred technique for most cases during an austere environment anesthesiology (AEA) mission because it allows conservation of resources for general anesthesia that may be required for more complicated surgeries or emergencies. Unfortunately, the technology and personnel support needed to employ general anesthesia successfully can exhaust the resources available during AEA.

B is incorrect. Austere environments such as disaster zones, developing countries, and war zones can frequently suffer from an inability to acquire and maintain a consistent supply of any type of medicines and equipment.

C is incorrect. Whether in or out of the OR, locations where PNBs are performed should have basic monitors, including ECG, blood pressure, and pulse oximetry.

D is incorrect. Any anesthetizing location where PNBs are performed, whether in or out of the OR, should be equipped with airway equipment, suction, supplemental oxygen, and medications in the event of an airway emergency.

General anesthesia with anesthetic vapors can be challenging in austere environments because:

A. It provides poor operating conditions.

B. It allows more patients to be treated with fewer resources.

C. Draw-over anesthesia is widely used by most anesthesiologists.

D. High-pressure oxygen may be required.

D is correct. Most modern anesthesia machines and workstations require the use of high-pressure oxygen (> 40–45 psi).

A is incorrect. General anesthesia is the gold standard for anesthesia in both austere environments and developed modern healthcare systems. Operating conditions for most procedures are very good.

B is incorrect. Regional anesthesia is the preferred technique for most cases during an AEA mission because it allows conservation of resources that may be required for more complicated surgeries, emergencies, or other cases not amenable to regional anesthesia.

C is incorrect. Most anesthesia workstations in modern developed healthcare systems employ an anesthesia machine requiring high-pressure medical gas. One solution to this problem is a draw-over anesthesia vaporizer breathing system. Draw-over systems require no electricity or high-pressure gas for the function of the machine or the circuit....

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