Dissociative anesthesia in an office-based plastic surgery practice

In 1974, the author began to use ketamine in association with diazepam for cosmetic and reconstructive procedures. Since then, through courses in the United States and abroad, well over a thousand plastic surgeons have been taught the technique. Ketamine, by itself, ablates sensory input of pain at the thalamic level but has been associated with hallucinations, bad dreams, and other untoward effects. These can be prevented by the use of benzodiazepines, which "bracket" the use of ketamine. If the patient is sedated and awakens under the influence of these agents, there is no adverse ketamine effect. Specific techniques and adjunct agents are described.