Postoperative vigilance in patients with total intravenous anaesthesia with ketamine/propofol

Ketamine is a strong acting analgesic drug, used mainly in trauma and emergency medicine settings, as well as for minor procedures. Its pharmacological properties make it a useful drug for military anaesthesia. Ketamine acts by blocking activation of the spinal and supraspinal NMDA-type glutamate and opioid receptors. It produces dissociative anaesthesia, which means that patients might remain conscious, though insensitive to pain and amnesic (anterograde). Dysphoria and hallucinations are the main side effects in the early recovery period. We studied the incidence of post operative nausea and vomiting, vigilance disturbances and haemodynamic instability during combined ketamine and propofol anaesthesia. No patient suffered from postoperative nausea and vomiting. No haemodynamic instability could be observed in any of the patients. The interesting point is that though there were no unpleasant emergence phenomenons, no patient reached the preoperative state of vigilance within two hours after extubation. These results indicate that for plastic/dermatological surgical procedures, patients undergoing ketamine/propofol anaesthesia do not require excessive haemodynamic monitoring, but do need prolonged personal observation in the postoperative period.