COMPARATIVE OBSERVATIONAL STUDY BETWEEN KETAMINE AND PROPOFOL VERSUS KETAMINE AND DEXMEDETOMIDINE FOR MONITORED ANAESTHESIA CARE IN DILATATION AND CURETTAGE SURGERIES.

Abstract

Anaesthesia is frequently administered through Monitored Anaesthesia Care utilising various combinations of anaesthetic drugs for moderately unpleasant operations like D and C. The hunt for improved drug combinations was ongoing, nevertheless, and it takes into account the pharmacological properties of the individual drugs. In this regard, anaesthesiologists all over the world are quite fond of the combination of Ketamine and Propofol, which was also known as KETOFOL. Recently, especially in situations involving MRI sedation, the combination of ketamine and dexmedetomidine (DEXKET) has gained popularity. In this study we compare both the combinations. Objectives: The primary objective was to estimate the recovery times from using either combinations and duration of analgesia. Secondarily we would also compare the hemodynamic profile, side-effect profile of the two combinations. Methods: Observational study with 60 patients posted for elective D and C. According to standard institutional protocols they were either administered KETOFOL or DEXKET depending on anaesthesia providers choice. Ketofol group received Ketamine 1mg/kg and Propofol 1mg/kg and with boluses of ketamine 0.25mg/kg to maintain depth of anaesthesia. DEXKET group received Dexmedetomidine intravenously 1μg/kg over a period of 10 minutes followed by ketamine 1mg/kg. Any further requirement will be boluses of Ketamine 0.25mg/kg to maintain adequate depth. Results: The Recovery time in post operative period was statistically significant with the KD group (mean 22.77 minutes) compared to KP group (mean 17.8 minutes). Total duration of analgesia was also longer in KD group (250 minutes vs 220 minutes in KP group). It was seen that the hemodynamic variables (HR, SBP, DBP) were consistently higher in the KD group compared to the KP group. There was a significant difference in SBP, DBP, MAP in intraoperative period between KP and KD group till 4hr in the post operative period. Conclusion: We conclude that combination of Dexmedetomidine and Ketamine has longer recovery times and duration of analgesia compared to Ketofol. It provides good hemodynamic stability. Side effect like post operative nausea vomiting are not significant.