Small doses of ketamine used in breast prosthesis surgery, when combined with a fixed dose of propofol, provide better sedation, amnesia, and adjuvant analgesic effects. In adults, the clinical application of ketamine is less common than in children, but it is more widely used, albeit with more side effects such as hallucinations, transient visual disturbances, headaches, nausea, vomiting. However, the side effects of ketamine are primarily due to psychomotor reactions, which have a significant dose-dependent relationship and occur more frequently in young female patients. Midazolam can effectively reduce the occurrence of these reactions. Bowdle's study on volunteers found that even small doses of ketamine may cause psychomotor reactions, with the incidence positively correlated to the dosage. White and others' studies demonstrated that the combination of small doses of ketamine and midazolam still results in a relatively high incidence of fantasy during surgery (25%). Our observations also indicate that combining small doses of ketamine with midazolam cannot completely avoid psychomotor reactions.
In total intravenous anesthesia, the respiratory effects of sedation and analgesia are the main concerns. In this observation, two patients experienced apnea after the loading dose, and 22 patients experienced tenesmus. Therefore, when administering total intravenous medication, close monitoring of respiratory management is necessary, paying strict attention to individual drug sensitivity. An additional group receiving fentanyl showed significant respiratory depression. Although sedation and analgesia offer certain advantages, they cannot completely eliminate surgical pain. Thus, perfect, full, and reliable local anesthesia is one of the key factors ensuring satisfactory anesthesia outcomes.
In conclusion, sedation and analgesia techniques, characterized by their simplicity, convenience, rapid recovery, fewer complications, and lack of pain memory, significantly enhance the local anesthetic effect in breast prosthesis surgery and improve patient comfort during the procedure.