I find some mixtures of drugs produce better end results than when these drugs are used alone or together but separately ( not mixed into single combination/solution )
I shall highlight one today, I have used combination of Propofol and Ketamine regularly to sedate patients on surgery under regional blockade ( I have to date done more than a few thousand anesthetics in this manner ). I combine 100mgs of Propofol with 100 mgs of Ketamine and induce sleep with 10 mgs of each purge. Once sleep is achieved, I titrate the infusion to maintain the patient in Ramsay Sedation score of 4/5 depending on the quality of block achieved. If the regional block quality is good then the sedation score is usually kept at 4 but if the block is patchy as it happens occasionally even in experienced hands I maintain a high Ramsay sedation score of 5. The combination pleasantly masks the patchy block albeit I generally advise my registrars and students to opt for General Anesthesia as first choice in case of a very unpleasant patchy block and/or an anxious patient.
Patients tolerate the combination better than either drug alone ( used alone to achieve target Ramsay score same as above ), requires less quantity of drug and surprisingly I found the emergence to be almost non existent. In a few patients where the emergence was seen it was not as bad as when Ketamine is used alone and was easily managed with Midazolam.
Drug combinations are dime a dozen with each practicing Anesthesiologist having one of his own ( the very basis of anesthesia being multi-modal approach or combined anesthesia approach ), it also makes sense as any single drug should not be treated as holy grail to achieve a target - whatever the pharma companies may claim.
However I find this combination useful and recommend it heartily to my fellow practitioners and request them to use the combination and come up with good and critical peer reviews.
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