Anaesthesia and critical care considerations in nerve agent warfare traumacasualties

Nerve agents (NA) (tabun, sarin, suman, VX) have been stocked around the wo rld for some time and still present a major threat to civilian as well as t o military populations. Since NA can be delivered through both an aerial sp ray system and a ballistic system, victims could suffer both NA intoxicatio n and multiple trauma necessitating urgent surgical intervention followed b y intensive care. These patients can be expected to be extremely precarious neurologically, respiratorily and haemodynamically. Moreover, their clinic al signs can be misleading. Further exacerbating the problem is the fact th at interactions of NA with the pharmacological agents used for resuscitatio n and/or during anaesthesia can aggravate organ instability even more and p ossibly cause systemic collapse. There are no protocols for perioperative c ritical care and early assessment or for the administration of anaesthesia for surgical interventions in such combined multiple trauma and intoxicated casualties. We propose a scheme for the administration of critical care an d anaesthesia based on the scant anecdotal reports that have emerged after the occurrence of local accidents involving NA intoxication and on the neur opharmacological knowledge of the pesticide organophosphate poisoning datab ase, these compounds being related chemical substances. (C) 2000 Elsevier S cience Ireland Ltd. All rights reserved.