S.N. Morozova, M.I. Tyukina, Municipal Healthcare Institution "City Hospital No. 1 named after N.A. Semashko," Rostov-on-Don. All surgeries performed for therapeutic purposes, and especially cosmetic ones, must be safe for the patient's health and life and be performed with minimal trauma. Anesthesia is of great importance in ENT surgery and surgical cosmetology, and each surgical procedure places specific demands on it. Through many years of experience at the ENT clinic, we have developed specific anesthesia techniques that are most appropriate for restorative, reconstructive, and plastic surgeries. Recently, intravenous and combined anesthesia based on neuroleptanalgesia, ketamine, and barbiturate have become widely used. The mandatory use of infiltration anesthesia for most ENT surgeries allows for the dosage of general anesthetics to be reduced to subnarcotic levels, making it possible to administer anesthesia while maintaining adequate spontaneous respiration. In recent years, we have been using ketamine for intravenous anesthesia. It has a hypnotic and pronounced analgesic effect and does not suppress the pharyngeal, laryngeal, or cough reflexes. Ketamine administration maintains adequate spontaneous pulmonary ventilation. Over the course of three years, we performed more than five hundred intravenous anesthesia procedures with preserved spontaneous breathing during ENT surgeries, including reconstructive procedures such as rhinoseptoplasty, rhinoplasty, paranasal sinus surgery, general middle ear surgery and tympanoplasty, otoplasty, reconstructive surgeries for congenital and acquired ENT pathologies, blepharoplasty, and removal of excess facial and neck skin. Anesthesia lasted from thirty minutes to an hour and a half. Premedication was achieved by intramuscular administration of potentiating mixtures 30-40 minutes before surgery. The most commonly used drugs that potentiate local anesthesia include: 1. Atropine (1 mg) – to prevent the bradycardic effect of succinylcholine and to suppress salivation. 2. Narcotic analgesics - promedol (20-40 mg), fentanyl (0.1-0.05 mg). 3. Tranquilizers - seduxen, relanium (10-20 mg) - relieve psychological stress, anxiety, fear, create psychoemotional comfort, up to euphoria. 4. Antihistamines - suprastin (20 mg), tavegil (10-20 mg) - to prevent allergic reactions, potentiate anesthetics and neuroleptics. Operations on the ENT organs and face, as a rule, are accompanied by bleeding, therefore premedication includes drugs that reduce bleeding, stimulate the physiological hemostatic mechanisms of the body. These include: etamsylate, dicynone, ?-aminocaproic acid. We begin anesthesia induction with benzodiazepines (seduxen 5 mg) to create psychoemotional comfort and nonspecific nociceptive blockade. We then administer ketamine at a rate of 0.5-1 mg per 1 kg of body weight. These doses do not cause respiratory depression. Anesthesia is maintained with intermittent administration of ketamine at a rate of 0.25-0.5 mg/kg. Individual dosage is determined not only by body weight but also by individual sensitivity. A significant advantage of ketamine compared to other anesthetics is its low rate of adverse events upon recovery from anesthesia (nausea, vomiting, chills, drowsiness, depression), which are often used by doctors and patients to assess the quality of anesthesia. Monitoring of systemic hemodynamics and external respiration ensures the safety of anesthesia during surgeries with preserved spontaneous breathing. Thus, intravenous ketamine anesthesia, especially in combination with local anesthesia, is the most advantageous, appropriate and rational method of pain relief in ENT surgeries and facial surgeries in reconstructive plastic surgery.