Ketamine and pancuronium for the shocked patient

Abstract

Hypovolaemia presents a dangerous situation in relation to the induction of anaesthesia.Ideally it should be corrected before induction but, when blood loss is severe and continuous, this may not be possible.The anaesthetist is then faced with the problem of inducing a shocked patient.Most intravenous induction agents cause hypotension, whereas ketamine (particularly when given intravenously) tends to have the opposite effect''2 and therefore offers a greater degree of safety when the patient is hypotensive.The muscle relaxant pancuronium, unlike other non-depolarising agents such as tubocurarine and alcuronium, is also well known to cause a rise in blood p r e ~s u r e .~