The Thai teens who were trapped in a flooded cavern last summer were given ketamine so they would not panic during the complicated rescue.
Twelve soccer players and their coach were left stranded in Thuam Lung cave after monsoon waters blocked the way out.
Rescue divers had to maneuver them through dark, tight, and flooded passage ways.
Anesthetists taught the divers when to re-sedate the boys, so they would not wake up and panic or be completely unconscious.
The boys who were stranded in a flooded Thai cave complex last July were given ketamine to prevent them from panicking during their risky rescue.
Ketamine is primarily used as a horse tranquilizer, but also has human medical applications, and was used during the rescue as a relatively simple way to anesthetize the teens as professional divers guided them out of tight cave paths one by one, the New England Journal of Medicine reported Thursday.
Read more: This timeline shows exactly how the Thai cave rescue unfolded
The 12 soccer players and their coach were stuck in the Thuam Lung cave complex in northern Thailand after it flooded during a monsoon, blocking the only exit.
Trapped for 17 days without food or water, they group were at risk if running out of oxygen, or drowning in rising flood waters.
A diagram of the Thuam Lung cave complex. Shayanne Gal/Business Insider
Narrow passageways with strong currents made it so hard for rescuers to reach the boys that a retired Thai Navy Seal died while making the crossing. It was important that the boys, none of whom knew how to dive, remained calm throughout the carefully planned rescue operation.
Read more: Former Thai navy SEAL working to rescue soccer team trapped in a cave has died
The divers administered the boys with "unspecified doses of ketamine" and gave them positive pressure full face masks, the medical report said.
According to the World Health Organization, ketamine can be a safer option than other anesthetics because it does not depress breathing or lower blood pressure. It also does not require expensive equipment to monitor the patient, so it is often used in areas with unreliable access to running water, electricity, and oxygen.
Dr. Richard Harris, an Australian anesthetist who contributed to the report, told the Daily Mail he had to teach rescuers when to re-sedate the boys. The timing was crucial: If they received too little, they could panic. If they were rendered unconscious, they might not have been able to respond to an emergency.
"The fact that our rescue strategy worked, and not just once but 13 times, still seems beyond the realms of possibility and I'm pinching myself that this has been the outcome," Dr. Harris said.
Armydds on December 8th, 2020 at 06:11 UTC »
A lot of people here seem to only know of ketamine as a street drug given in random and unpredictable/unknown doses without realizing that it's used every single day in almost every hospital in the world that provides sedation and general anesthesia. This is not remotely like having all the kids drop acid or shoot up some heroin. Ketamine is not a weird or unusual drug to use in a medical setting at all, though it's used in much different and more controlled dosing than I'd assume is common in recreational use. I perform IV sedation for multiple patients every day and a lot of them get a small dose of ketamine along with other agents. It's used because it's predictable in its effects and extraordinarily safe in most situations when dosed correctly. It can also be given intramuscularly unlike most other sedation medications, which would be advantageous in a Thai cave full of children as starting a whole bunch of IVs on already terrified children would be difficult even in the best of situations. This would be doubly so if it had to be administered by rescuers with limited to no advanced medical training. Additionally, it provides a substantial amount of pain control unlike most of the non-narcotic sedation agents, which may or may not have been useful in this case.
For this situation, it's the perfect drug because you can give it, reasonably safely, in a situation where you can't monitor vital signs and oxygenation. It can provide much more profound sedation than any of the oral anxiolytics, which is probably important when needing to wedge terrified children out of a cave. Most importantly, it's one of the very few agents that can provide predictable and effective moderate to deep sedation without affecting the respiratory drive. Benzos, narcotics, and most of the other effective anesthetic agents can easily stop a patient's breathing. If you don't have monitors or medical breathing devices, the kids could have easily died if their breathing slowed and it wasn't recognized and corrected. Ketamine doesn't really affect the respiratory drive, which is pretty unique for sedation agents. A little too much fentanyl can easily kill someone if breathing isn't supported. A lot too much ketamine, while not overly pleasant, is still very unlikely to kill an otherwise healthy person without underlying cardiovascular disease, especially a healthy child. Also, unlike many other anesthetic agents, it won't lower blood pressure or heart rate to potentially unsafe levels. It's also widely used in military field medicine and in some EMS situations for all of the same reasons, in addition to it's routine hospital use.
In short, if one is in a situation where you need to sedate someone relatively deeply in a remote setting with little to no medical monitoring equipment and limited emergency drugs/equipment, ketamine is the safest and most effective choice. I can't really think of another viable option actually, assuming you need the patient to be relatively deeply sedated, which is a reasonable need when squeezing a bunch of kids out of a hellish cave system. If you polled every anesthesiologist in the world for what drug they'd recommend in a situation like this, I doubt you'd have many other answers.
imgoingtowar on December 8th, 2020 at 05:38 UTC »
RIP Saman Gunan
HE_3AKOH_BPATAH on December 8th, 2020 at 05:27 UTC »
They gave them a carefully selected dose of ketamine and a benzodiazepine based on their weight to prevent them from freaking out while scuba diving in narrow environments and ripping their masks off, which would be endanger them and their rescuers. Saw the documentary on YouTube lol