[Analgetic ketamine feasible in ambulance emergency care]. / Analgeticum ketamine goed toepasbaar in de ambulancehulpverlening.

OBJECTIVE: To investigate if ketamine could be a feasible analgetic in ambulance trauma care. DESIGN: Prospective. SETTING: University Hospital of Rotterdam 'Dijkzigt'. METHODS: To 51 women and 87 men in the age of 9-95 years who suffered from pain due to trauma and needed pain relief during transport to the hospital, a low dose of ketamine was given according to protocol. Their pain was measured with a descriptive verbal pain scale every 5 minutes. RESULTS: Upon arrival in the hospital 125 (90.5%) out of the 138 patients had a relief of their pain. For 101 patients the pain was only minimal or had disappeared during transport. This was reached in 74 cases with only one dose of ketamine, in 26 cases a second dose was needed, a same number needed nitrous oxide in addition and 9 times a second dose and nitrous oxide was given. Side-effects were mostly of psychic origin, such as agitation (9%), disorientation (17%), sedation (27%), and hallucinations (5%). They never lasted longer than several minutes or hindered further investigation. CONCLUSION: A low dose ketamine seems a safe and feasible analgetic in ambulance trauma care. Further research which compares ketamine with other in the ambulance trauma care current analgetics seems of value.

Glaucoma following retinal detachment operations.

After retinal detachment operations 1-5% of the patients develop glaucoma. If this occurs directly after the operation it is the result of mechanical narrowing of the chamber angle. This can be the result of indentation due to an exoplant or encircling band causing forward displacement of the lens/iris diaphragm. Other causes are torsion of the ciliary body or a ciliary block due to serous detachment of the choroid caused by venous compression or diathermy. Ischaemia of the anterior segment sometimes leads to glaucoma in the long run; this is then the result of rubeosis iridis. Conducive factors are detachment of the recti muscles, arterial and venous compression by the exoplant or encircling band and the use of diathermy. When performing such operations it is advisable to take these risks into account and to keep a check on the intraocular pressure after the operation. A patient is described who, as the result of ischaemia, eventually developed ribeosis iridis with neovascular glaucoma, leading to loss of the eye.