The Australian anesthetist Dr. Harry Harris was interviewed on the ACCRAC podcast recently. Really amazing conversation:
In this 242nd episode I welcome Dr. Richard “Harry” Harris to the show to discuss his incredible experience saving the lives of the Thai boys soccer team that was trapped in a flooded c…
accrac.com
TLDR for those who don't want to listen:
-He didnt want to do this but the kids were going to die in the next few days in the cave.
-They had to induce GA because the kids and divers would both die if anyone lost their cool. He thought that the kids would probably die of hypoventilation, water asphyxiation or laryngospasm, or hypothermia.
-The kids were all ideal patients (skinny and healthy)
-He considered different agents: precedex, clonidine, benzos, etc, but ultimately decided on ketamine since he has a lot of experience using ketamine as a sole agent in austere conditions. He could find no literature of repeat IM dosing of ketamine for maintenance GA (I think the swim took 7 hours?).
-Premedicated with ~20mcg/kg atropine to help with secretions. Gave a very small dose (unsure what) of IM midazolam for anxiolysis. Gave IM ketamine ~5mg/kg initial dose; the kids were re-dosed with ~1mg/kg q45mins by the (non-medical) rescue divers during the dive.
-During the dive, some of the kid's respiratory rates got down to 3/min. He thinks this may have been a combination of the sedatives and the cold water.
-The kids were transported with hands and feet tied behind back, floating face-down. This helped with secretions. The full face-masks had a CPAP function that probably saved their lives. It kept water out in the event of small leaks, kept airways open, and also allowed the divers to give a breath by pushing a button on the mask.
