Target controlled infusion of ketamine as analgesia for TIVA with propofol

To determine the accuracy of a target controlled infusion system for ketamine and to assess its suitability for the provision of analgesia when used in conjunction with a propofol infusion in spontaneously breathing patients.

Nineteen, adult, ASA I-III patients scheduled for elective surgery were studied. After premedication with 20 mg temazepam an appropriate plasma concentration of ketamine was selected and, when the target controlled infusion (TCI) system indicated that this had been achieved, anesthesia was induced and maintained using a propofol infusion. The plasma ketamine concentration was measured at predetermined intervals and cardiovascular and respiratory parameters recorded at 10 min intervals. Patients were reviewed in recovery and 24 hr postoperatively to assess the adequacy of their recovery and the presence of any undesirable side effects.

The TCI system had a median performance error against predicted plasma concentrations of 18.9% (SE 2.5%) and a median absolute performance error of 23.3% (SE 2.3%). Divergence was 20.3% (SE 30.1%) and wobble was 12.9% (SE 2.1%). There was a mean decrease in arterial pressure of 6.4% (SD 19.7%) and a mean increase in heart rate of 4.3% (SD 17.4%). Little respiratory depression occurred and all patients made a rapid postoperative recovery with none describing unpleasant dreams or hallucinations.

The TCI system provided a clinically acceptable degree of control of the plasma ketamine concentration although some further improvement should be possible by amending the pharmacokinetic model. Clinically the combination with a propofol infusion proved to be a satisfactory anesthetic technique.