An intravenous dissociation technique for outpatient plastic surgery: tranquility in the office surgical facility

Intravenous diazepam and ketamine may be used as sole agents, along with local anesthesia, or in combination with preoperative sedation in office plastic surgical procedures. These medications can lower or, in some instances, eliminate the requirements for local anesthesia. They enable procedures traditionally confined to hospital operating rooms (where general anesthesia must be used) to be done in office surgical facilities. True dissociation occurs, and this is not seen without the use of ketamine, which selectively and centrally blocks the effect of painful stimuli without obtunding vital functions. Use of these two agents together is mandatory, because of the use of ketamine alone can produce unwanted side effects. Together, diazepam and ketamine exhibit synergism, with the adverse effects of each being canceled by the other. This dissociative technique appears to approach the "ideal" in a properly staffed and equipped office surgical facility with appropriate patient selection. Tranquility can now be a reality for the patient, staff, and plastic surgeon.