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AMBULATORY ANESTHESIA

The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain

Department of Anesthesiology, University of Louisville School of Medicine, Louisville, Kentucky

Address correspondence and reprint requests to Rosendo F. Mortero, MD, Department of Anesthesiology, University of Louisville School of Medicine, Louisville, KY 40292. Address e-mail to rashep01{at}gwise.louisville.edu

We compared the effects of coadministration of propofol and small-dose ketamine to propofol alone on respiration during monitored anesthesia care. In addition, mood, perception, and cognition in the recovery room, and pain after discharge were evaluated. In the Propofol group (n = 20), patients received propofol 38 ± 24 µg · kg^-1 · min^-1. The Coadministration group (n = 19) received propofol 33 ± 13 µg · kg^-1 · min^-1 and ketamine 3.7 ± 1.5 µg · kg^-1 · min^-1. Respiration was assessed by using end-expiratory PCO₂ measurements at nasal prongs. After surgeries, mood, perception, and thought were assessed by using visual analog scales, and cognition was assessed by Mini-Mental State Examination (MMSE). Pain after discharge was assessed by a five-point rating scale in the evening for 5 days. End-expiratory PCO₂ was lower in the Coadministration group (P < 0.0001). Mood and MMSE scores were higher in the Coadministration group (P < 0.004 and P = 0.001, respectively). Pain scores and analgesic consumption after discharge were less in the Coadministration group (P = 0.0004 and P < 0.0001, respectively). We conclude that coadministration of small-dose ketamine attenuates propofol-induced hypoventilation, produces positive mood effects without perceptual changes after surgery, and may provide earlier recovery of cognition.

Implications: Simultaneous use of small-dose ketamine during propofol sedation improves ventilation and produces positive mood states in the recovery room. The combination of drugs may also provide earlier return of cognitive function.

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