An approach to outpatient anesthesia using drugs that have reversible or very short-acting effects is described, along with a method of monitoring patients using pulse rate to assess tranquility.
Preoperatively, the patient is given 1 mg of lorazepam the evening before surgery and sublingual lorazepam 1 mg combined with hydroxyzine 50 mg intramuscularly one hour before surgery. Before infiltration of local anesthesia, intravenous diozepam in 2.5 mg increments is given if needed, followed by a mixture of meperidine is given if needed, followed by a mixture of meperidine and pentazocine intravenously in exactly a 10:1 ratio. If hypnosis is needed, methohexital can be adminstered using a 0.2% drip by infusion pump.
If respiratory depression is seen, intravenous naloxone, 0.2 to 0.4 mg, can be given to reverse any residual effects of meperidine and perntazocine, or, if large doses of intravenous diazepam have been used in a very agitated patient, one can administer physostigmine 1 to 2 mg.
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