Ketamine and propofol for TIVA

was excessive in 12.5% overall. Three patients exhibited abnormal movements after premedication, one following the smaller dose. There were no significant changes in heart rate, blood pressure or arterial oxygen saturation. Ketamine alone has a foul taste, but it was well accepted when disguised in orange juice, although one vomited 45 minutes later. The pharmacokinetics of oral ketamine and its metabolite norketamine are interesting. Although the bioavailability of oral ketamine is low at 16.5%, the peak plasma norketamine levels are much higher than those after the same dose intramuscularly.' Norketamine probably has anaesthetic and analgesic properties and this possibly accounted for the remarkable lack of response to venepuncture or arterial cannulation. We were attracted by the analgesic and sedative effects of oral ketamine, but the salivation, hypocarbia and dreaming were undesirable side effects in our patients. Eventually, we returned to more conventional premedicant drugs because of disquiet due to the passivity and abnormal movements, but not before combining oral trimeprazine and oral ketamine which rectified the salivation and hyper-