Total intravenous anaesthesia: a technique using flunitrazepam, ketamine, muscle relaxants and controlled ventilation...

A potentially acceptable and uncomplicated technique of total intravenous anaesthesia is described using flunitrazepam for induction, and maintenance by ketamine infusion with neuromuscular blockade and controlled ventilation using oxygen-enriched room air. A significant complication was the 23% incidence of nausea and/or vomiting encountered in the fifty-six patients studied. Definite factual recall of the surgical experience was reported by one patient. This was attributable to an accidental error in technique. Postoperative drowsiness was also a feature of the technique. The usual cardiovascular and psychomimetic effects associated with ketamine administration appeared markedly attenuated by flunitrazepam induction. Fifty-three (96.3%) patients expressed their willingness to receive the same anaesthetic again. Further experience of total intravenous anaesthesia with the introduction of cerebral function monitoring, allowing correlation of depth of anaesthesia with drug dosage, should allow further refinement of the technique to ensure successful and acceptable anaesthesia.