Total intravenous anaesthesia for military surgery. A technique using ketamine, midazolam and vecuronium

Ketamine and midazolam were used for induction of anaesthesia and by continuous intravenous infusion for maintenance to assess their suitability for use in a total intravenous anaesthetic technique in the management of battle casualties. Muscular relaxation was provided by vecuronium and the patients' lungs ventilated with air. Ketamine was infused at a rate of 2 mg/kg/hour. This was achieved by mixing ketamine 200 mg, midazolam 5 mg and vecuronium 12 mg in 50 ml normal saline. The rate of infusion of the mixture (ml/hour) was then equal to 50% of the body weight in kg. The technique proved to be simple, effective and versatile and should be adaptable for use in the management of battle casualties.