Where there is no anaesthetist: a study of 282 consecutive patients using intravenous, spinal and local infiltration...

Two hundred and eighty-two consecutive surgical operations were performed over a period of 11 months, February-September, 1991, December 1991-February 1992 at two private medical centres. Anaesthesia was conducted by the surgeon assisted by the theatre nurses. Intravenous ketamine was given in 72% of operations, xylocaine infiltration in 12.8%, spinal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients. Major and minor surgical operations were performed on 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine anaesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patients. Hypotension at induction and postoperative headache/neck stiffness were the principal side effects in spinal anaesthesia occurring in 59.2% and 12.8%, respectively. Reversible apnoea occurred in three patients and cardiac arrest in one patient of those who had intravenous thiopentone. It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient selection, intravenous ketamine, spinal and local infiltration anaesthetic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel and in settings poorly equipped for cardiopulmonary resuscitations.