Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.

Inadvertent perioperative hypothermia (IPH) occurs when a patient experiences a core temperature below 36° C (96.8° F) in perioperative settings and is a preventable risk factor for anesthesia‐ and surgery‐related complications. Forced‐air warming is an effective method to maintain normothermia. This study compared four interventions for preventing IPH for 120 patients undergoing primary elective unilateral total knee or total hip arthroplasty. The study was based on a time series nonequivalent comparison group design to investigate whether the incidence of IPH differed among treatment groups. We also sought to determine whether the patients’ preoperative perceptions of warmth or cold correlated with core body temperatures. Patients receiving convective warming and prewarming appeared to experience fewer IPH events than patients in the other study groups. This study suggests that hypothermia is a common issue for patients undergoing total knee or total hip arthroplasty and that it may be possible to reduce its frequency.