KETAMINE IN THE FIELD - THE USE OF KETAMINE FOR INDUCTION OF ANESTHESIA BEFORE INTUBATION IN INJURED PATIENTS IN THE FIELD

Intubating the subconscious, struggling patient in a pre-hospital sett ing can be a difficult task even in experienced hands. We performed a clinical prospective study to evaluate the applicability of ketamine f or induction of anaesthesia before intubation in the field. Ketamine w as distributed to all air medical rescue teams - trained reserve army volunteers from various medical specialties. Lectures and literature c oncerning the use of ketamine for anaesthesia induction before intubat ion were given. The physicians were instructed to administer ketamine, in a close of 2 mg/kg intravenously if a single intubation attempt Ja iled. Following the administration of ketamine, a questionnaire was fi lled in by the physician. Analysis of the data was performed after 24 months. During the study period, intubation was indicated in 161 injur ed patients evacuated by air in Israel. In 29 patients (18 per cent) t he first intubation attempt had failed and they were given ketamine. T he reasons for failure of the first intubation attempt were restlessne ss or trismus in 23 patients and traumatic distortion of the upper air way anatomical landmarks in six. Following ketamine administration, in tubation was successful in 19 patients (65.5 per cent), ii? all of who m the il?dication for ketamine administration was restlessness or tris mus. All patients with upper airway anatomy distortion weve given a cr icothyroidotomy. There were no complications attributed to ketamine. A ll patients reached hospital alive. This preliminary study suggests th at the use of ketamine in this pre-hospital setting is safe. The drug is effective in cases where the primary reason for failure to intubate is restlessness or trismus. The drug is not effective in cases of ana tomical damage to the upper airway. In these cases, cricothyroidotomy should probably be performed as early as possible. (C) 1997 Elsevier S cience Ltd.