RT Book, Section
A1 Buckenmaier, Chester C.
A2 Hadzic, Admir
SR Print(0)
ID 3508040
T1 Chapter 66. Regional Anesthesia in Austere Environment Medicine
T2 NYSORA Textbook of Regional Anesthesia and Acute Pain Management
YR 2007
FD 2007
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071449069
LK accessanesthesiology.mhmedical.com/content.aspx?aid=3508040
RD 2024/04/23
AB Regional  anesthesia  has  played  a  pivotal  role  in  the  development  of  anesthesiology  as  a  medical  specialty  since  the  discovery  of  the  local  anesthetic  properties  of  cocaine  by  Carl  Köller  in  1884.  In  the  decades  since  this  landmark  discovery,  surgeons  and  anesthesia  providers  have  appreciated  the  advantages  of  regional  anesthesia  in  their  patients,  particularly  in  surgical  situations  complicated  by  limited  resources  and  austere  environmental  conditions.  War,  more  than  any  other  human  endeavor,  has  driven  the  need  to  provide  effective  anesthesia  for  surgery  in  austere  environments.  Indeed,  the  development  of  anesthesiology  as  a  distinct  specialty  has  been  attributed  to  the  medical  experience  obtained  in  World  War  II.1  The  physician–anesthetists  of  that  era  quickly  recognized  that  regional  anesthesia  imparted  the  least  physiologic  insult  to  the  wounded  soldier  and  allowed  a  more  awake  patient  to  be  returned  to  the  recovery  ward,  thus  reducing  the  burden  on  limited  wartime  medical  resources.1  As  anesthesiology  matured  as  a  medical  specialty  and  departments  of  anesthesiology  began  to  break  away  from  departments  of  surgery  in  academic  centers,  regional  anesthesia  continued  to  evolve.  During  the  Vietnam  War,  the  value  of  regional  anesthesia  in  harsh  medical  conditions  was  reestablished.  In  one  series  of  1000  battle  casualties,  nerve  block,  spinal,  or  local  anesthesia  was  used  in  49%  of  cases.  “This  allowed  increased  anesthesia  coverage  of  more  surgical  procedures  at  any  one  time  as  well  as  decreasing  the  demands  on  postoperative  ward  personnel  in  a  multiple  casualty  situation.”2  The  role  of  regional  anesthesia  in  combat  casualty  care  continues  to  expand  in  modern  conflicts.  Consequently,  military  medical  planners  are  understandably  interested  in  austere  environment  anesthesia  due  to  the  realities  of  military  wartime  missions.  Civilian  anesthesiologists  are  also  interested  in  the  advantages  of  regional  anesthesia  in  austere  environments  for  disasters,  civil  defense,  or  missions  to  medically  underserved  regions  of  the  world.