title: Combination propofol/ketamine is a safe and efficient anesthetic approach to anorectal surgery.
abstract: OBJECTIVE
  Concerns persist regarding respiratory complications from combination deep intravenous sedation and local anesthesia for prone position anorectal surgery. We examined the safety and efficacy of this approach by using a propofol-based and ketamine-based technique.
  
  
  METHODS
  A retrospective review was conducted on all patients undergoing anorectal surgery. Outcomes (perioperative times, specific complications) were compared with respect to operative position and anesthetic approach. Significance was determined using Student's t-test and chi-squared analysis.
  
  
  RESULTS
  Surgery was performed on 448 patients during a three-year period. There was no significant difference in the two anesthetic groups with regard to age and gender. There were 19 anesthesia-related adverse events occurring in the study group (Monitored Anesthesia Care Group): nausea and vomiting (n = 8), airway obstruction necessitating conversion to general anesthesia (n = 2), excessive pain (n = 2), urinary retention (n = 5), and hospital readmission (n = 2). These occurred in <5 percent of those receiving the combination technique (19/407). Although there was no difference in total procedural time, there was a significant difference in total time spent in the operating room (P = 0.001) and in the hospital overall (P = 0.002). Of the patients receiving combination technique anesthesia, only 31 (7 percent) required the use of the postanesthesia care unit. All patients receiving general anesthesia (n = 23) required the postanesthesia care unit.
  
  
  CONCLUSIONS
  Combination deep intravenous sedation with local anesthesia based on propofol and ketamine is a safe and effective technique for prone-position anorectal surgery. It results in decreased use of the postanesthesia care unit and earlier hospital discharge, reflecting a more efficient use of hospital resources.
authors.affiliation: Section of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01608, USA.
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Sun
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Canete
authors.forename: John C
authors.initials: JC
authors.lastname: Friel
authors.forename: Janet
authors.initials: J
authors.lastname: McDade
authors.forename: Sudershan
authors.initials: S
authors.lastname: Singla
authors.forename: Craig A
authors.initials: CA
authors.lastname: Paterson
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Counihan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012449:Safety
chemical_list: D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D015742:Propofol