The value of ketamine (CI-58 1 'Ketalar') in paediatric anaesthesia has been widely reported 1 2. Various authors have described specific situations where ketamine may be the anaesthetic of choice in adults, but general acceptance has been less enthusiastic for routine procedures394. The unique properties of this agent, however, provide a special attraction for physicians working in developing countries where equipment and anaesthetic expertise may be limited 5 . The British Solomon Islands, comprising ten large islands or island groups and outlying islands, extend 900 miles over the Western Pacific, between latitudes 5"s and 12"s. The total population is estimated at 160,OOO, who are mainly Melanesians. The islands are divided for administrative purposes into four districts. Scheduled sea and air services now link the districts with Honiara, the capital ofthe Protectorate, where a specialist surgeon and physician are stationed at the main government hospital. The specialists visit the district hospitals at regular intervals and patients may be transferred to Honiara if expert medical help is required. The following clinical trial was undertaken at Malaita district hospital which is the medical centre for some 60,000 people. The hospital was completed in 1967; it has 112 beds including general, obstetric and tuberculosis wards. A trained nurse or medical assistant is responsible for the single-handed funning of each ward and the heavy demands of district touring frequently leave only one medical officer to supervise the hospital and a busy out-patient department. Seventy-six major and 326 minor operations were performed in a well equipped operating theatre during 1971. The EMO ether vaporiser, with or without thiopentone induction, has, until recently, provided the sole means of general anaesthesia and although safe and reliable, the medical officer without anaesthetic experience often found induction prolonged and troublesome. The claim that ketamine provides a simple and safe anaesthetic for the lone surgeons appeared to be relevant to the situation in the Solomon
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