The Art of Safe Anesthesia in Unsafe Environments

Trauma remains one of the leading causes of preventable mortality worldwide, with an especially disproportionate impact in low- and middle-income countries (LMICs). Despite resource constraints, clinicians in low-resource environments have developed pragmatic, innovative, and highly adaptive strategies to deliver anesthesia for trauma care. This review synthesizes key lessons from low-resource settings that can inform trauma anesthetic practice globally—particularly in mass casualty events, austere environments, and health-system disruptions. Recent literature highlights the effectiveness of simplified trauma protocols, context-appropriate airway strategies, damage control resuscitation with limited blood products, ketamine-centered anesthesia, early regional anesthesia, and the utilization of robust non-technical skills. Experiences from humanitarian missions and LMIC trauma centers demonstrate that outcomes can be improved even when technological, pharmaceutical, and workforce resources are limited. These insights provide a blueprint for resilience and preparedness in higher-resource nations during crises. Anesthesia for trauma in low-resource environments emphasizes flexibility, essentialism, decisive action, and multidisciplinary coordination. These lessons—drawn from austere surgery, LMIC trauma systems, and global anesthesia programs—can enhance trauma preparedness and improve survival across all settings.