CONCEPTS FOR ANALGESIA AND SEDATION - KET AMINE AND PROPOFOL

In a ''concept for differentiated analgesia and sedation'', ketamine a nd propofol can be combined either with each other or with other subst ances. Ketamine has powerful analgesic but weak narcotic properties an d, via the stimulation of central sympathetic areas, brings about an i ncrease in blood pressure, heart rate and cardiac output. A bronchospa sm is favourably influenced Propofol has a markedly narcotic, but no r elevant analgesic effect and, in particular when injected rapidly and at a high dose, has clearly negative effects on the cardiovascular sys tem. While ketamine permits excellent ''vertical'' control, propofol h as distinct advantages in terms of ''horixontal'' control In combinati on with midazolam, ketamine is particularly suitable for analgesia/sed ation in patients with instable haemodynamics and patients with bronch ial asthma or chronic obstructive pulmonary disease. The advantages of propofol are to be seen in the initial phase of analgo-sedation, in w hich its good properties with respect to recovery can be utilized as a ''diagnostic window'', as also in the uncomplicated withdrawal and re covery phase. Characteristic of the combination of ketamine with propo fol are the stable dynamic situation - although there is no evidence o f a saving of catecholamines - and the good ''horizontal'' control wit h rapid recovery.