A Comparative Study between Use of Propofol-Ketamine and Propofol-Fentanyl in Total Intravenous Anesthesia for Laparoscopic Surgeries

Abstract

Background: Total intravenous anesthesia has advantages over traditional inhalational anesthesia. It has the advantages of hemodynamic stability, ease of titration using targeted control infusion systems, less organ toxicity, preservation of hypoxic pulmonary vasoconstriction, and reduction of intra- cerebral pressure, risk reduction of postoperative nausea and vomiting, less atmospheric pollution and more economic. Propofol as a strong anesthetic but has no property of internal analgesia; so, a quick action opioid like fentanyl is usually used for helping in analgesia. Aim of the work: The aim of this study was to compare between propofol-ketamine and propofolfentanyl as a drug combination used for total intravenous anesthesia in laparoscopic surgeries as regarding hemodynamic state, intraoperative analgesia, recovery time, postoperative analgesia, nausea and vomiting as well as emergence reactions. Patients and Methods: This comparative study was conducted between July 2017 and June 2019 at Sayed Galal University Hospital on 40 adult patients with sex and age matched. Their age ranged between 20-50 years old. They were randomly divided into two equal groups depending on drug combination used, Propofol-Ketamine Group (I) and Propofol-Fentanyl Group (II). The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Results: The mean intraoperative blood pressure in Group (I) was higher than Group (II) with statistically significant difference between both groups p˂0.001. The comparison between the mean of pain (VAS) score, sedation (Ramsay’s score) and recovery time of patients in both groups shows that means were higher in PropofolKetamine Group than Propofol-Fentanyl Group and there was statistically significant difference between them p˂0.05. In this study, nausea/vomiting were more common in Group (I) than Group (II) with statistically significant difference between them (p˂0.05). Emergence reaction (unpleasant dreams or hallucinations) were more evident in Group (I) with statistically significant difference. Conclusion: There was no significant difference in the average number of heart beats and peripheral oxygen saturation. The combination of Propofol-Ketamine leads to more hemodynamic stability. The combination of Propofol-Fentanyl leads to faster recovery than the combination of Propofol-Ketamine for procedural sedation and analgesia in patients undergoing laparoscopy. Nausea/vomiting were more common significantly in group (I). Emergence reaction was more evident in group (I) and was statistically significant.