Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
02
05
2019
accepted:
22
09
2019
entrez:
5
10
2019
pubmed:
5
10
2019
medline:
17
3
2020
Statut:
epublish
Résumé
Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations. This study aimed to describe and analyze French anesthetic activity in a deployed military setting. Between 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. During 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. In 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.
Sections du résumé
BACKGROUND
Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.
OBJECTIVE
This study aimed to describe and analyze French anesthetic activity in a deployed military setting.
METHODS
Between 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.
RESULTS
During 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.
CONCLUSION
In 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.
Identifiants
pubmed: 31584991
doi: 10.1371/journal.pone.0223497
pii: PONE-D-19-12376
pmc: PMC6777794
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0223497Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Trauma. 2006 Jun;60(6):1155-61; discussion 1161-4
pubmed: 16766956
Med J Aust. 2000 Dec 4-18;173(11-12):586-9
pubmed: 11379496
Cochrane Database Syst Rev. 2009 Oct 07;(4):CD006459
pubmed: 19821368
Mil Med. 2015 Oct;180(10):1075-82
pubmed: 26444470
J Spec Oper Med. 2016 Fall;16(3):30-35
pubmed: 27734439
Injury. 2009 May;40(5):493-7
pubmed: 18656190
Mil Med. 2012 Aug;177(8):939-46
pubmed: 22934374
Ind Psychiatry J. 2014 Jul-Dec;23(2):149-56
pubmed: 25788805
JAMA Surg. 2018 Sep 1;153(9):800-807
pubmed: 29847675
Reg Anesth Pain Med. 2003 Jul-Aug;28(4):321-7
pubmed: 12945026
BMC Womens Health. 2016 May 26;16:27
pubmed: 27230890
Anesthesiology. 2016 Mar;124(3):561-9
pubmed: 26881395
Soc Sci Med. 2002 Mar;54(5):649-61
pubmed: 11999484
Mil Med. 2004 Jan;169(1):23-9
pubmed: 14964497
J R Army Med Corps. 2015 Dec;161 Suppl 1:i10-i12
pubmed: 26621807
Hernia. 2017 Oct;21(5):749-757
pubmed: 28676927
Surgery. 2014 Sep;156(3):642-9
pubmed: 24661767
Mil Med. 2015 May;180(5):533-8
pubmed: 25939107
Acta Anaesthesiol Scand. 2008 Jul;52(6):727-37
pubmed: 18477070
Lancet. 2015 May 30;385(9983):2209-19
pubmed: 25662414
Int J Nurs Pract. 2010 Apr;16(2):166-75
pubmed: 20487062
Disasters. 2010 Oct;34 Suppl 3:S406-26
pubmed: 20846352
Anesth Analg. 2014 Feb;118(2):454-63
pubmed: 24445643
Arch Surg. 2008 Jun;143(6):564-9
pubmed: 18559749
J Trauma. 2003 May;54(5):814-21
pubmed: 12777893
Br J Anaesth. 2010 Jul;105(1):9-20
pubmed: 20551025
Mil Med. 2013 Apr;178(4):385-8
pubmed: 23707821
Anesthesiology. 2007 Dec;107(6):1003-8
pubmed: 18043069
Surgery. 2017 Aug;162(2):366-376
pubmed: 28400124
Soc Sci Med. 2014 Nov;120:421-9
pubmed: 24928172
Mil Med. 2006 Aug;171(8):762-9
pubmed: 16933819
Arch Surg. 2005 Jan;140(1):26-32
pubmed: 15655202
Mil Med. 2017 Mar;182(3):e1756-e1761
pubmed: 28290955
Mil Med. 2005 Jun;170(6):473-5
pubmed: 16001594
Surgery. 2016 Nov;160(5):1414-1421
pubmed: 27407057
Soc Sci Med. 1994 Nov;39(9):1249-59
pubmed: 7801162
J Med Ethics. 2005 Oct;31(10):571-4
pubmed: 16199596
Reg Anesth Pain Med. 2016 Jan-Feb;41(1):43-9
pubmed: 26650430