Propofol/Ketamine for MAC case

yoga crna · Jun 13, 2006

I use the combination frequently and think it works very well.

First, be sure to cover the CNS effects of ketamine with midazolam. If it is a long procedure, I frequently give the midazolam IM (5-10mg, depending on age and weight of patient). For short procedures, I give the versed IV.

Mixture of propofol 200 mg (20cc) and Ketamine 50 mg together in 20 cc syringe. I use an infusion pump and tittrate to effect, giving more when the surgeon is injecting local to cover the pain of injection and less when all I need is sedation because the patient is well anesthetized with local. The have been times when I have added fentanyl 50ug to the mixture--it helps keep the heart rate down from the ketamine and epinephrine in the local.

Be sure to shake the syringe well, because of the viscosity of propofol.

It is not a particular good technique if the surgeon is not skilled with local anesthesia or if a patient has hypertension that is not under good control.

It has been promoted by Dr. Barry Friedberg as the best technique ever, which hasn't been shown to be true in my hands.

apaisRN, RN, CRNA · Jun 14, 2006

It is very popular at my current clinical site. I am not experienced enough to compare with other techniques but in general it seems to work well. Ketamine is a really neat drug under appropriate circumstances.

PANurseRN1 · Jun 18, 2006

I hate taking care of pts. after they've gotten ketamine. They wake up totally wacked out...screaming, hallucinating, sometimes even combative. We do quite a few pain mgmt. procedures where I work, and the pts. who get ketamine are just off the wall afterwards.