title: Anaesthesia and critical care considerations in nerve agent warfare trauma casualties.
abstract: Nerve agents (NA) (tabun, sarin, suman, VX) have been stocked around the world for some time and still present a major threat to civilian as well as to military populations. Since NA can be delivered through both an aerial spray system and a ballistic system, victims could suffer both NA intoxication and multiple trauma necessitating urgent surgical intervention followed by intensive care. These patients can be expected to be extremely precarious neurologically, respiratorily and haemodynamically. Moreover, their clinical signs can be misleading. Further exacerbating the problem is the fact that interactions of NA with the pharmacological agents used for resuscitation and/or during anaesthesia can aggravate organ instability even more and possibly cause systemic collapse. There are no protocols for perioperative critical 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 and anaesthesia based on the scant anecdotal reports that have emerged after the occurrence of local accidents involving NA intoxication and on the neuropharmacological knowledge of the pesticide organophosphate poisoning database, these compounds being related chemical substances.
authors.affiliation: Post-Anaesthesia Care Unit, Tel Aviv Sourasky Medical Centre, The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel. draviw@tasmc.health.gov.il
authors.forename: A A
authors.initials: AA
authors.lastname: Weinbroum
authors.forename: V
authors.initials: V
authors.lastname: Rudick
authors.forename: G
authors.initials: G
authors.lastname: Paret
authors.forename: Y
authors.initials: Y
authors.lastname: Kluger
authors.forename: R
authors.initials: R
authors.lastname: Ben Abraham
mesh_terms: D000777:Anesthetics / Q000009:adverse effects; D000931:Antidotes / Q000627:therapeutic use*; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D000075202:Contraindications; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007306:Insecticides / Q000009:adverse effects; D009104:Multiple Trauma / Q000628:therapy*; D009943:Organophosphorus Compounds; D011041:Poisoning / Q000188:drug therapy; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*
chemical_list: D000777:Anesthetics; D000931:Antidotes; D002619:Chemical Warfare Agents; D002800:Cholinesterase Inhibitors; D007306:Insecticides; D009943:Organophosphorus Compounds; D011729:Pyridostigmine Bromide