WHERE THERE IS NO ANESTHETIST - A STUDY OF 282 CONSECUTIVE PATIENTS USING INTRAVENOUS, SPINAL AND LOCAL INFILTRATION ANESTHETIC TECHNIQUES

Two hundred and eighty-two consecutive surgical operations were perfor med over a period of 11 months, February-September, 1991, December 199 1-February 1992 at two private medical centres. Anaesthesia was conduc ted by the surgeon assisted by the theatre nurses. Intravenous ketamin e was given in 72% of operations, xylocaine infiltration in 12.8%, spi nal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients. Major and minor surgical operations were performed o n 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine an aesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patie nts. Hypotension at induction and postoperative headache/neck stiffnes s were the principal side effects in spinal anaesthesia occurring in 5 9.2% and 12.8%, respectively. Reversible apnoea occurred in three pati ents and cardiac arrest in one patient of those who had intravenous th iopentone. It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient s election, intravenous ketamine, spinal and local infiltration anaesthe tic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel a nd in settings poorly equipped for cardiopulmonary resuscitations.