Bioterrorism and the anaesthesiologist's perspective

The use of non-conventional agents aimed at causing panic and terror among civilians has a long history. There have been uninterrupted threats and the use of biological and chemical weaponry from the time of early tribal conflicts to the Iran–Iraq war. The sole practical experience has come from the release of the nerve gas Sarin in a Tokyo subway (1994) and the inhalational anthrax discovered in Florida (2001). Drills that simulate scenarios of biological/chemical mass infestation have yielded valuable theoretical experience. This chapter reviews the main chemical and biological agents possibly obtainable by individuals and groups, and the anaesthesiologist's tasks during the resultant non-conventional multi-casualty scenarios. It briefly illustrates the chemical and biological pathological effects of the various intoxicants on the human body, and describes modes of protection and the currently available treatment, based on both military and civilian materials and on the authors' own experience derived from specially designed drills.