The Utilization of Ketamine as an Adjunct with Spinal and Epidural Analgesia

Abstract

Spinal and, to a lesser degree, epidural anesthesia has experienced more wawes of popularity and unpopularity than any other method. One of the chief reasons was the fear of the lumbar puncture which was due to either the patient’s dreadful recollection of a previous unpleasant personal experience or just a hearsay evidence from a well-informed drinking partner in the neighbourhood bar. The usual first question asked after the convincing, comforting, reassuring words from the visiting anesthesist is: “Will I be awake during the operation?” “To be or not to be ?” This is the question which we ask ourselves, for to give rather large doses of an intravenous adjunct to those regional techniques would nullify their advantages over other general anesthetic methods. On the other hand, to perform a block could be a spectacular technical achievement with a continuously moving patient, not speaking of the necessity of the stand-by “psycho-anesthesist” — to use George P. Pitkin’s expression, “to maintain the patients on the table and distract their minds from the frightening unknown.”