In my own practice, the ‘pirate anaesthesia’ was the introduction to entering this technique, i. e. a prehospital technique was secondarily imported to the clinic (as it happened for the other prehospital anaesthesia principles. Now many references can be found, both for elective and for emergency use, and some are definitely previous to my own use. Most disturbing is the terminological confusion applied to the random use of “sedation” or “anaesthesia” for this method [171]. Even when we try to keep the risks low in all kinds of anaesthesia, we should not trick out ourselves and our patients in claiming that the use of anaesthetics, even in producing some kind of unresponsive state (unconsciousness?), is “just a sedation.” The same confusion has occurred several times in the ICU, leading to an unexpected revelation of adverse effects by long-term use of anaesthetics (designed, tested and approved only for short-term use), and not only etomidate (“the cortisol-story”) was discredited thereby.

Preconditions for the technique is a sufficient breathing with a sufficiently anaesthetized condition. Employing it for emergencies will often require haemodynamic stability and always some obscure mechanism for preventing aspiration. I believe this is also where concern for the airway reflexes come in, but the topic is open for exploration.