EMERGENCY ANESTHESIA IN THE PREHOSPITAL SETTING IN ADULT PATIENTS: NARRATIVE REVIEW AND PROPOSALS FOR CLINICAL PRACTICE

Abstract

DOI: https://doi.org/10.46296/yc.v9i17.0775

Abstract

Introduction: Emergency anaesthesia in the prehospital setting in adult patients, also known as prehospital emergency anaesthesia (PHEA), is an advanced intervention aimed at securing the airway, optimizing ventilation and enabling diagnostic or therapeutic procedures in out-of-hospital environments. Although it is performed in a small proportion of emergency medical service activations, its impact on morbidity and mortality may be substantial, particularly in patients with major trauma, neurological impairment or acute respiratory failure. Objective: To describe the pathophysiological principles, indications, drugs, techniques and complications associated with emergency anaesthesia in the prehospital setting in adults, and to summarize practical recommendations that can be adapted to emergency medical systems in middle-income countries such as those in Latin America. Methods: A narrative review of the literature was conducted using biomedical databases (PubMed, Scopus and Google Scholar), supplemented with clinical practice guidelines from international scientific societies on advanced airway management and prehospital anaesthesia. Original articles, reviews and consensus documents published mainly between 2015 and 2025 in English and Spanish, addressing prehospital emergency anaesthesia in adults, were included. Results: PHEA is based on a modified rapid sequence induction with orotracheal intubation, achieving high success rates when performed by trained teams, although it still carries a risk of haemodynamic and respiratory complications. The most frequently used drug regimens combine opioids, hypnotics and neuromuscular blocking agents, with ketamine and rocuronium standing out for their profile in critically ill patients. Appropriate drug selection, anticipatory planning, monitoring and teamwork are key to minimising adverse events. Conclusions: Emergency anaesthesia in the prehospital setting is a complex and high-risk intervention that should be performed to standards similar to those in hospital, within systems with strong clinical governance. Strengthening staff training, protocol standardisation and local research is essential to improve safety and outcomes in adult patients managed in prehospital environments.

Keywords: prehospital emergency anaesthesia; airway management; rapid sequence induction; out-of-hospital emergency care.