Trelles Centurion Miguel, Van Den Bergh Rafael, Gray Henry
Surgical Care Unit - Operational Centre Brussels, Médecins Sans Frontières - Doctors Without Borders, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium.
Operational Research Unit - Operational Centre Brussels, Médecins Sans Frontières - Doctors Without Borders, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium.
Curr Anesthesiol Rep. 2017;7(1):1-7. doi: 10.1007/s40140-017-0190-0. Epub 2017 Feb 16.
Disasters and armed conflicts are characterized by high numbers of trauma cases, and occur mainly in developing countries where the healthcare response is already impaired, resulting in an inadequate response. Aside of the trauma cases, other surgical health conditions are also still present and require urgent care. Surgical care needs are different from context to context and depend on local means and capabilities.
Doctors without Borders (MSF) has proven that even in precarious situations, safe administration of anesthesia is possible, and the "do no harm" principle can and must be upheld. Anesthesia providers need to recognize the difficulties linked to these contexts.
Local, spinal and general intravenous (mainly with Ketamine) anesthetics seem to be the most widely accepted. Inhalation anesthesia has constraints; regional is underused and epidural is not recommended. Standard operative procedures should be in place, and an informed consent from the patient must be granted.
灾难和武装冲突的特点是创伤病例数量众多，且主要发生在医疗保健应对能力已经受损的发展中国家，导致应对不足。除了创伤病例外，其他外科健康状况也依然存在，需要紧急护理。外科护理需求因情况而异，取决于当地的资源和能力。
无国界医生组织（MSF）已证明，即使在不稳定的情况下，也能够安全实施麻醉，并且“不伤害”原则能够且必须得到坚持。麻醉提供者需要认识到与这些情况相关的困难。
局部、脊髓和全身静脉麻醉（主要使用氯胺酮）似乎是最被广泛接受的。吸入麻醉有局限性；区域麻醉未得到充分利用，不建议使用硬膜外麻醉。应制定标准手术程序，并且必须获得患者的知情同意。
