[Ketamine/flunitrazepam--an alternative intravenous anesthesia]

In a controlled randomized study, 21 patients who received a combination of ketamine and flunitrazepam with relaxation and N2O/O2-ventilation were compared with 20 patients who received neuroleptic analgesia (NLA) for intra-abdominal surgery. The two groups of patients were comparable with respect to age, sex, type of surgery, time of operation and coexistent diseases. The dosage of ketamine chosen was a total of 0.92 mg/kg per hour. For maintenance of anaesthesia, only 0.5 mg/kg per hour was used. In combination with 0.7-1.0 mg flunitrazepam and N2O/O2 ventilation, this low dose of ketamine was satisfactory. Electroencephalographic and electromyographic recordings demonstrated and adequate level of anaesthesia. The determination of serum free fatty acid levels showed a well-balanced in stress. Occasional elevations of blood pressure--which also were seen in the NLA-group--were not overcome by increasing the ketamine dosage. A brief addition of enflurane or isoflurane was more effective. The immediate postoperative onset of spontaneous respiration without complications and with normal CO2 levels was remarkable. The method was well accepted by the anaesthetist responsible and the nursing personnel.