Journal of the Royal Naval Medical Service
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Ketamine is a strong acting analgesic drug, used mainly in trauma and emergency medicine settings, as well as for minor procedures. Its pharmacological properties make it a useful drug for military anaesthesia. Ketamine acts by blocking activation of the spinal and supraspinal NMDA-type glutamate and opioid receptors. ⋯ No haemodynamic instability could be observed in any of the patients. The interesting point is that though there were no unpleasant emergence phenomenons, no patient reached the preoperative state of vigilance within two hours after extubation. These results indicate that for plastic/dermatological surgical procedures, patients undergoing ketamine/propofol anaesthesia do not require excessive haemodynamic monitoring, but do need prolonged personal observation in the postoperative period.
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Letter Biography Historical Article
Subject: Re: John Pollard, 1787-1868.
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The battlefield has changed. UK and US Forces in Iraq and Afghanistan are engaged in asymmetric, three bloc warfare. Three bloc warfare indicates that what is effectively war-fighting occurs in parallel with peace-keeping and humanitarian operations. ⋯ Damage control surgery requires support in the form of environmental control, adequate diagnostics (including computerised tomography) and effective intensive care facilities if the patient is to survive. Teams need to be highly trained and to have experience of complex surgery and trauma. They must be adequately resourced if lives are to be saved.