[Total intravenous anesthesia using ketamine and midazolam. A simple technic]

Forty unpremedicated patients undergoing minor gynecological surgery were anesthetized with 1 mg ketamine and 0.1 mg midazolam per kg bodyweight, if necessary supplemented later with half the initial dose. All patients continued to breathe room air spontaneously with no ventilatory support. There were no incidents of airway obstruction and only 1 case of troublesome airway secretions. The arterial blood gas sample did not show any sign of respiratory depression, but in 11 cases paO2 was lower than normal, though acceptable. The median emergence time was 6 min. The side effects of ketamine were well controlled by midazolam, and patient acceptance of the technique was high. We consider that the technique may be suitable for short procedures under primitive conditions, for example after mass casualties, and that it can, if necessary, be applied by specially trained paramedics.