BACKGROUND: Even when patients agree that anesthesia is indispensable for a safe and comfortable operation, they are reluctant to experience the side effects of conventional general and regional anesthesia. We investigated whether monitored anesthetic care (MAC) using propofol, ketamine, fentanyl, and ketolorac can be substituted for conventional anesthesia in minor surgery. METHODS: One hundred forty six healthy adult patients who received minor surgery were studied. All were fasted, premedicated, and monitored according to conventional general anesthesia. Fentanyl 2 microgram/kg, propofol 1 mg/kg, ketamine 0.2 mg/kg, and ketorolac 30 mg were given intravenously and propofol was maintained at 3 4 mg/kg/h. Before local anesthetics infiltration at the incision site, ketamine 5 mg and propofol 20 mg were added intravenously. During the procedure, fentanyl 25 microgram plus propofol 20 mg were added whenever involuntary movements appeared. We observed vital signs, complications, time to eye opening to verbal command, time to regain orientation, satisfaction with anesthesia, postoperative pain scores, and analgesic consumption. RESULTS: Blood pressure and heart rate were reduced at the beginning of anesthesia, but were not clinically significant. Intraoperatively, respiratory depression (40.4%), SpO2 < 90% (25.3%) were observed, but no patients needed tracheal intubation. Postoperatively, dizziness (29.5%), pain (20.5%), and nausea (15.8%), were observed. The time to eye opening and to regaining of orientation were 57.3+/-119.4 sec, and 8.0+/-4.7 min respectively. Satisfaction with anesthesia was remarkable; surgeon (76.7%), patients (91.8%). Postoperative pain scores were low; 59.6% of patients did not need analgesics for the first 24 h. CONCLSIONS: If careful monitoring and instantaneous management for respiratory depression by anesthesiologist is provided, MAC using PKFK is an excellent and readily applicable method for minor surgery.