Anaesthesia in austere environments.

The scope of this review is by necessity somewhat limited and, as said in the introduction, methods used will depend on the skills and experience of the practitioner involved. The triservice apparatus remains the system of choice for delivering volatile anaesthetic agents to patients in areas without the infrastructure to supply an endless quantity of medical gases, the planned isolated or battle conditions of Boultons scenarios. The TSA's portability, robust design and versatility have stood the test of time. By reviewing intravenous agents the author has attempted to find an evidence base for the most appropriate agent for a non anaesthetic trained doctor finding his or herself called on to provide emergency anaesthesia in the field. The most useful drug is ketamine which has the advantage of cardiovascular stability, preservation of airway reflexes, ease of administration via different routes and versatility for providing analgesia, sedation or general anaesthesia.