Rapid anesthesia induction in combat casualties with full stomachs

A series of 50 combat-injured patients given crash intubation for rapid induction of anesthesia is presented. The technic consisted of injection of 3 mg of d-tubocurarine and 0.4 mg of atropine IV, preoxygenation by face mask for 3 minutes, and then injection of sodium thiopental or ketamine, followed immediately by 60 to 80 mg of succinylcholine IV. Intubation was performed with a cuffed tube after cessation of spontaneous respirations and relaxation of the jaw. In the entire series there was no vomiting or aspiration on induction. Thirty-six patients were induced with thiopental and 14 with ketamine. Three patients given thiopental and 2 given ketamine had a fall in blood pressure to below 100 torr systolic. The average BP change was in a positive direction with both agents.