Badrinath S et. al., Anesth Analg 2000;90:858-62

Reviewed by: R. Prasad, MD

Summary:
-Premed midaz 2mg. NCO2 3L.
-Propofol + ketamine (0.94-1.88 mg/ml):

• effective deep sedation/analgesia
• 40-56% needed chin lift
• VSS
• no delay in discharge
• less opioid required intraop

Comments:
-This is in agreement with what we do sometimes
-Relatively small # in each group (25). Wonder about incidence of psych sx in larger sample. Here, Group 3 had 2pts 8% with psych sx, for example.

Details:
-100 females, outpt breast bx under local
-randomized, double-blind, placebo-controlled
-premed, then infusion of propfol + ...

• Group 1: saline
• Group 2: ketamine 0.94mg/ml
• Group 3: ket 1.88 mg/ml
• Group 4: ket 2.83 mg/ml

Results:
-ketamine caused dose-dependent dec in rescue opioid (in response to local infiltration and throughout)
-10 to 15mmHg dec in MAP (not statistically signif)
-no change in HR, no bradypnea, no desat <90% in any group
-Reqd chin lift: Group 1-52%, 2-56%, 3-40%, 4-20%
-with Group 4, inc in PONV, psychomimetic side effects (dreams, hallucinations), visual changes (double vision, nystagmus) and discharge times.