Anaesthesia for the surgeon‐anaesthetist in difficult situations

In many developing countries the physicianJpopulation ratio is less than 1 :20,000. Under these conditions the ideal of employing a physician for routine anaesthesia is hardly justified and often impossible. Unfortunately, the conditioning of surgeons trained in the more affluent areas is such that most are unwilling or unable to administer their own spinal or local anaesthetics. Many anaesthetists, particularly those trained within the British Commonwealth, lack experience of anaesthesia without the aid of compressed gases and thus are unable to train technicians for work outside major centres. There is great need for a safe, simple anaesthetic that can be administered by the surgeon or an assistant under his supervision. It must leave the surgeon free to forget about the patient’s general condition and airway whilst he concentrates on the surgery. Recovery should be rapid and free from any special nursing requirements. In Nigeria phencyclidine was found to meet some of these criterial. Unfortunately this drug also caused major psychotomimetic disturbances which led to its withdrawal from the field of human anaesthesia. The possibility that the phencyclidine congener 2(0-chlorophenyl)-2 methylamino cyclohexanone hydrochloride (Ketamine*) might be an improvement on the parent compound was suggested from published reports2-8 which concern both the clinical and pharmacological aspects of the drug. The drug is a water soluble compound which may be administered by intravenous or intramuscular injection. Intravenous administration proved disappointing in our hands. It was found to be unreliable in producing anaesthesia, to give such a short period of analgesia that constant attendance was necessary, to cause a marked rise in blood pressure and distressing hallucinations. Although the