Physostigmine in recovery from anaesthesia

Intravenous ketamine anaesthesia has been used by the British army in the field for many years. A recognised problem has been the unpredictable recovery profile this produces. We anaesthetised 28 ASA 1 patients using a standard British military technique. At termination of the anaesthetic, half of the patients were given a physostigmine/glycopyrronium mixture and half were given the equivalent volume of saline 0.9%. There was a significant difference between the two groups with regard to recovery times (p < 0.001). There was no significant difference with regard to other variables. In trauma anaesthesia the improved recovery profile from the use of physostigmine following ketamine anaesthesia may lead to earlier evacuation of the patient.