The clinical application of a small dose of ketamine in breast prosthesis with fixed propofol provides better sedation, amnesia, and adjuvant analgesic effects. The clinical application of ketamine in adults is less common than in children but more widely used, though it comes with more side effects such as hallucinations, transient visual disturbances, headaches, nausea, vomiting. However, the side effects of ketamine are mainly due to psychomotor reactions, which have a significant dose-dependent relationship, occurring more frequently in younger female patients. Midazolam can effectively reduce the incidence of these reactions. Bowdle's study on volunteers found that even small doses of ketamine may cause psychomotor reactions, with the incidence positively related to the dosage. White and others' studies have shown that when small doses of ketamine and midazolam are combined, there is still a relatively high incidence (25%) of fantasies during surgery. Our observations also indicate that combining small doses of ketamine and midazolam cannot completely avoid psychomotor reactions. In total intravenous anesthesia, the respiratory effects of sedation and analgesia are of main concern. In this observation, two patients experienced apnea after loading, and tenesmus occurred in 22 patients. Tips for total intravenous medication include close monitoring of respiratory management, strictness, and attention to individual drug sensitivity. One additional fentanyl group showed obvious respiratory inhibition. While sedation and analgesia techniques have some advantages, they cannot completely eliminate surgical pain. Therefore, perfect, full, and reliable local anesthesia is one of the key factors ensuring satisfactory anesthetic effects. In conclusion, sedation and analgesia techniques, with their simple use, convenience, rapid recovery, fewer complications, and no pain memory, can significantly improve the local anesthetic effect in breast prosthesis operations and enhance the patient's comfort during the procedure.