Just wanted to see what others had to say about this. A particular neurosurgeon at my hospital now does only pain-related procedures. Lum-lams, cervical fusions, intradiscal electrothermy (percutaneous), etc. His standing "orders" to anesthesia: versed decadron toradol zofran diprivan sux volatile so far, so good . . . . . . absolutely no narcotics of any kind no paralysis - pt will breath spontaneously throughout the procedure ketamine 0.4 mg/kg q 30 minutes, max three doses. What's interesting is that 99.9% of his pts do quite well, are easily extubated within 2-3 minutes of the dressing going on, and are very comfortable in PACU. His cases rarely go longer than two hours. Occasionally I wonder why all pts aren't done this way?