PURPOSE: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.
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