This study included 40 patients divided into two groups each includes 20 patients. Analgesic dose of ketamine (0.3-0.5 mg before induction of anesthesia) was given to the patients to obtain a basal reading then patients were divided into two groups. Ketamine group (K group) where ketamine was used for induction and maintenance of anesthesia and ketamine –propofol group (KP group) where ketamine was used for induction and ketamine and propofol were used for maintenance of anesthesia TceMEP was performed by transcranial electrical stimulation and myogenic recording of compound muscle action potential (CMAP) from right and left tibialis anterior muscles. By comparing the results from both groups we conclude that combination of ketamine with propofol was successful and associated with low incidence of adverse effects of ketamine alone using multipulse TceMEP