Major disasters, during which large numbers of injured must be hospitalized, require specific medical measures. To obtain the most efficient results, the simplest means must be used at the site of the disaster to provide: the prevention of pain and shock; the maintenance of vital metabolic functions; the administration of local and general anesthesia; and the medical supervision of the transport of critically injured and the post-operative care of the patients. It must be taken into account that the use of non-physicians to help anesthesiologists may be necessary. These individuals work under the direction of the physician.

Pain relief must be provided by sedatives and analgesics which cause minimal central respiratory depression, no increased stimulation to cardiac patients, and no increase in intracranial pressure in head injuries. An additional requirement is that no unwieldly apparatus is required. These criteria are met with the narcotic, sodium-4-hydroxybutyrate (SomsanitR).

In 1950, Roberts and Frankel (1) investigated the effects of gamma-aminobutyric acid (GABA) on the regulating system for the sleep rhythm of the mammalian cerebrum. Two years later, Roberts and his co-workers (2-4) showed that GABA is reduced in the brain by a specific transaminase to a semial-dehyde of succinic acid (succinylsemialdehyde) and this, in turn, is reduced to a dehydrogenase, which is probably identical with lactate dehydrogenase, to gamma- or 4-hydroxybutyric acid. Since parenterally administered amino butyric acid is unable to pass through the blood-brain barrier, Laborit and his team (5,6) searched for derivatives which could reach the central nervous system via the cardiovascular system and found that 4-hydroxy-butyric acid has this property.