The effects of total intravenous anesthesia using propofol, ketamine, and vecuronium on cardiovascular response and wake up time

Total intravenous anesthesia (TIVA) can be an effective alternative to inhalational anesthesia. Various techniques of TIVA have been associated with significant cardiovascular alterations and prolonged wake up times. The purpose of this study was to determine if TIVA utilizing propofol, ketamine, and vecuronium would provide stable hemodynamics in normotensive ASA physical status I and II patients and allow rapid awakening upon completion of surgery. Anesthesia was induced with propofol 1.0 mg/kg intravenously (IV), followed immediately by ketamine 1.0 mg/kg IV and vecuronium 0.1 mg/kg IV. Anesthesia was maintained by constant infusion of propofol 100-200 micrograms/kg/min and ketamine 17-34 micrograms/kg/min. This combination maintained hemodynamic stability and provided a rapid wake up time in 80% of the 40 subjects. The remaining 20% experienced significant tachycardia and hypertension or premature ventricular contractions. The mean wake up time was 9.7 minutes from time of neuromuscular blocking reversal to time of extubation. TIVA can be accomplished with propofol, ketamine, and vecuronium; however, 20% of patients experienced side effects, which make this method less attractive compared to alternative anesthetic techniques.