Intramuscular ketamine in a parturient in whom pre-operative intravenous access was not possible.

We describe the management of a 23-yr-old woman with extreme needle and mask phobia, presenting for an emergency Caesarean section for fetal distress. She also suffered from spina bifida cystica with no sensation from mid thigh. Regional anaesthesia, rapid sequence induction, and gaseous induction were not possible. She was managed successfully with i.m. ketamine followed by a more conventional anaesthetic technique.