An Intravenous Dissociation Technique for Outpatient Plastic Surgery

Vinnik, Charles A.

doi:10.1097/00006534-198106000-00016

Cited by 52 publications

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confidence: 99%

“…[20][21][22][23][24][25][26][27] Diazepam and lorazepam have been the most successful, but their use may prolong recovery time, making them less desirable in the ED setting. [22][23][24][25][26][27] Midazolam has also been used in this regard, but data are limited. Despite this paucity of data, available literature does suggest that compared with ketamine alone 28 or a combination of diazepam and ketamine, 29,30 midazolam results in fewer emergence reactions and a shorter time to complete recovery.…”

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A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Chudnofsky

Weber

Stoyanoff

et al. 2000

Academic Emergency Medicine

123

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Abstract. Objective:To describe the clinical characteristics of a combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department (ED) patients. Methods: This was a prospective, observational trial, conducted in the ED of an urban level II trauma center. Patients Ն 18 years of age requiring procedural sedation and analgesia were eligible, and enrolled patients received 0.07 mg/kg of intravenous midazolam followed by 2 mg/kg of intravenous ketamine. Vital signs were recorded at regular intervals. The adequacy of sedation, adverse effects, patient satisfaction, and time to reach discharge alertness were determined. Descriptive statistics were calculated using statistical analysis software. Results: Seventy-seven patients were enrolled. Three were excluded due to protocol violations, three due to lack of documentation, and one due to subcutaneous infiltration of ketamine, leaving 70 patients for analysis. The average age was 31 years, and 41 (59%) were female. Indications for procedural sedation and analgesia included abscess incision and drainage (66%), fracture/joint reduction (26%), and other (8%). The mean dose of midazolam was 5.6 Ϯ 1.4 mg and the mean dose of ketamine was 159 Ϯ 42 mg. The mean time to achieve discharge criteria was 64 Ϯ 24 minutes. Five patients experienced mild emergence reactions, but there were no episodes of hallucinations, delirium, or other serious emergence reactions. Eighteen (25%) patients recalled dreaming while sedated; twelve (17%) were described as pleasant, two (3%) unpleasant, three (4%) both pleasant and unpleasant, and one (1%) neither pleasant nor unpleasant. There were four (6%) cases of respiratory compromise, two (3%) episodes of emesis, and one (1%) case of myoclonia. All of these were transient and did not result in a change in the patient's disposition. Only one (1%) patient indicated that she was not satisfied with the sedation regimen. Conclusions: The combination of midazolam and ketamine provides effective procedural sedation and analgesia in adult ED patients, and appears to be safe.

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confidence: 99%

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Chudnofsky

Weber

Stoyanoff

et al. 2000

Academic Emergency Medicine

123

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“…Propofol (Diprivan, Zeneca) and ketamine (Ketalar, Parke-Davis) technique [1] is this anesthesiologist's evolution of Vinnik's diazepam (Valium, Roche) and ketamine technique for office anesthesia [2,3]. Diazepam is an agent with a high margin of safety, which is important if it is to be given by the surgeon as Vinnik recommends.…”

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Propofol-Ketamine Technique: Dissociative Anesthesia for Office Surgery (A 5-Year Review of 1264 Cases)

Friedberg

1999

Aesthetic Plastic Surgery

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Abstract. Propofol-ketamine technique is a room air, spontaneous ventilation (RASV), intravenous dissociative anesthetic technique which simulates the operating conditions of general anesthesia without the increased equipment requirements or costs. A total of 2059 procedures were performed on 1264 patients by 38 different surgeons. There were no hospital admissions for postoperative nausea and vomiting (PONV) or uncontrolled pain. All patients were pleased with their anesthetic and no hallucinations were reported. Cost:benefit analysis is presented as well as discussion of dissociative anesthesia being exempt from current California law (AB595).

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“…All aesthetic and virtually all reconstructive plastic surgical procedures can be done by this method. 6 …”

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confidence: 99%

Dissociative Anesthesia in an Office-Based Plastic Surgery Practice

Vinnik

2007

Seminars in Plastic Surgery

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In 1974, the author began to use ketamine in association with diazepam for cosmetic and reconstructive procedures. Since then, through courses in the United States and abroad, well over a thousand plastic surgeons have been taught the technique. Ketamine, by itself, ablates sensory input of pain at the thalamic level but has been associated with hallucinations, bad dreams, and other untoward effects. These can be prevented by the use of benzodiazepines, which ''bracket'' the use of ketamine. If the patient is sedated and awakens under the influence of these agents, there is no adverse ketamine effect. Specific techniques and adjunct agents are described.

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An Intravenous Dissociation Technique for Outpatient Plastic Surgery

Cited by 52 publications

References 0 publications

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Propofol-Ketamine Technique: Dissociative Anesthesia for Office Surgery (A 5-Year Review of 1264 Cases)

Dissociative Anesthesia in an Office-Based Plastic Surgery Practice

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