Dissociative anesthesia for safety's sake: ketamine and diazepam--a 35-year personal experience

Recent discussions and proposed rules and regulations regarding outpatient surgery facilities have raised the question of the appropriateness of general anesthesia versus heavy sedation. The controversy is based mostly on anecdotal information and the prejudice of the authors. A recent article that describes the improved platelet function induced by ketamine adds patient safety to the rationale for sedation. Most of us have trained in university settings where an entire department was devoted to general anesthesia and little true outpatient surgery was performed. When ambulatory facilities were available, they were usually staffed by anesthesiologists. Indeed, the first free-standing outpatient surgery center in Phoenix, Arizona, was owned and operated by a local group of anesthesiologists. Properly administered, diazepam and ketamine dissociative sedation is safe and effective for every aesthetic procedure, regardless of size or duration, and it should be available for all aesthetic surgeons. In the author's experience, more than 30,000 procedures have been performed with this method since 1966 without a single case of deep vein thrombosis or pulmonary embolus. In contrast, a former associate, because of his lack of experience, chose to use general anesthesia for a few larger cases in another facility. One of those cases, an abdominoplasty, resulted in a serious case of deep vein thrombosis with subsequent alleged disability and litigation. Therefore, the author is writing to share his extensive experience with his colleagues in hopes that these safe systems will become more widespread and to spare future patients the attendant unnecessary increased morbidity and mortality associated with general anesthesia.