Opioids are not the answer. Opioids are the problem.

Opioid free anesthesia leaves the patient in better postoperative condition than reducing intra-operative opioid use.

50 mg IV ketamine 2-5 minutes pre-skin stimulation saturates midbrain NMDA receptors providing opioid free preemptive analgesia.

Dose & timing essential!

Incrementally titrated propofol to BIS <75 with baseline EMG provides a stable CNS level of propofol to ward off ketamine associated negative side effects.

The magic interval (i.e. after 50 mg IV ketamine 2-5” pre-incision) between the time the cortex was denied knowledge of the surgeon’s invasion of the body (i.e. skin incision) and the time it understands the invasion has occurred is ‘magical’ because healing takes place during that interval with a dramatic decrease in postoperative analgesia requirements.

FWIW, recently spoke with a PACU RN who, interestingly enough, had worked with me in a local plastic surgeon’s office over 14 years ago & saw Goldilocks anesthesia up close & personally. Ran into her at my local hospital & she told me they were experiencing a dihydromorphone (Dilaudid®) shortage &, as a result, the anesthesiologists have been using ketamine instead.

She noted the patients were coming to PACU in much better condition. Who’d have thought? <sarcasm>

Watch my talk from the European Society for Perioperative Care of Obese Patients (ESPCOP) & Opioid Free Anesthesia meeting in Bruges, Belgium Dec. 16, 2017

Opioid Free Goldilocks Anesthesia Lecture…    https://youtu.be/hTFK4SCVZtQ

Why ignore an unparalleled 25-year success in >6,000 patients without a single hospitalization for pain or PONV?