Repeat ketamine anaesthesia of a child for radiotherapy in the prone position

Sixteen ketamine anaesthetics over an eight-week period for a course of postoperative radiotherapy following removal of a medulloblastoma in an 18-month-old child are described. On each occasion the child was in the prone position with a tight fitting shell covering the head, trunk and arms. The problems of repeated anaesthetics, isolation of the child in one room from the anaesthetist in another, and psychological upset to the mother and child are discussed. Ketamine was chosen because with this agent the patient usually maintains a clear airway, even in unusual postures. It was used successfully by both the intramuscular and rectal routes, thus avoiding repeated venepuncture and intubation. Post-anaesthetic nausea was a problem, but tolerance to ketamine and psychological emergence phenomena did not occur.