A nurse caring for a patient notes that the patient has a temperature of 104°F, and a heart rate of 110 beats/min. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss:

A. Propofol itself can cause pain at the injection site, but the use of a local anesthetic prior to infusion is not routinely recommended. Pain can sometimes be minimized by using a larger vein, slower administration, or lidocaine mixed with the propofol, but prophylactic local anesthetic at the IV site is not standard practice.

B. Propofol is a lipid emulsionand is highly prone to bacterial contamination. Open vials should not be refrigerated for extended periods; they are generally discarded within 6 hours of openingto reduce the risk of infection, especially propofol-related sepsis.

C. Propofol dosing for continuous sedationis weight-based, typically administered as mg/kg/hr, to maintain appropriate sedation levels and minimize adverse effects such as hypotension or oversedation. Close monitoring of infusion rates is essential.

D. Extended propofol infusions can cause propofol infusion syndrome, a rare but life-threatening condition characterized by rhabdomyolysis, hyperkalemia, metabolic acidosis, and cardiac failure. A CPK >5000 units/Lmay indicate rhabdomyolysis, and the infusion should be discontinued immediatelyto prevent further complications.

E. Propofol can cause respiratory depression and hypotension, even at standard doses. Nurses must ensure airway management and resuscitation equipment are readily available, and continuous monitoring of respiratory status, oxygen saturation, and hemodynamicsis required during administration.

A. Ketamine does not allow patients to remember their surgical experience. On the contrary, it produces amnesia, so patients typically have little to no recollection of the procedure. This amnesic effect is an important component of its anesthetic action.

B. Ketamine is not simply a paralytic. While it may reduce movement, it provides both anesthesia and analgesia, meaning it relieves pain as well as inducing a trance-like, unconscious state. It is not a drug that merely immobilizes the patient.

C. Ketamine is classified as a dissociative anesthetic, which means it induces a trance-like state in which the patient feels detached from their body and environment. This dissociation allows surgical procedures to be performed while the patient is unaware of pain and has a sense of separation from what is happening. Unlike some other anesthetics, ketamine maintains protective airway reflexes, spontaneous breathing, and cardiovascular stability, making it especially useful in emergency settings, pediatric procedures, or in patients with unstable cardiovascular status. The unique dissociative properties also make it useful for short procedures and sedation outside of the operating room.

D. Ketamine does not allow patients to move freely in a controlled manner during surgery. While some reflexive movementsmay occur, the patient is generally unresponsive to painful stimuliand unaware of the procedure due to the dissociative anesthesia and analgesia.