RESUMO
This retrospective study updates the experiences of a single surgeon with ketamine hydrochloride, which were first presented in 1977. It includes 1,102 cases over nearly 14 years. Ketamine was used for 434 emergency and 668 elective procedures; 285 were minor, 609 intermediate and 208 major cases. The duration of anaesthesia was adequate for many of the procedures, but was increased by repeated infusions. There seemed no limit to, or danger from, the number of repeat infusions. However, in 103 cases, ketamine was supplemented by general anaesthesia. The range of operations included most of the systems, but the majority were obstetric-gynaecological, orthopaedic and gastro-intestinal - comprising 25, 18 and 15 percent respectively. The ages ranged from 2 weeks to 87 years, most being in the third decade. The only contraindication was severe hypertension: it was indicated in all other cases, especially in oligaemic shock where it boosted and maintained the blood pressure. The main advantages were that it was readily administered by any medical personnel, required less staff pre- and post- operatively, the patient breathed spontaneously with preservation of his pharyngeal and laryngeal reflexes, and recovered consciousness quickly. It was especially advantageous for Caesarean section. The only disadvantage was that the patient occasionally became excited and garrulous, or had vivid hallucinations, but these were preventable by adequate premedication. Thus this study reiterates that the use of ketamine hydrochloride is safe and adequate in a wide range of surgical procedures, and is a boon especially in regions short in staff and supplies (AU)
