Hysteroscopic procedure as day care cases under TIVA with Dexmedetomidine vs Ketamine

Abstract

Background: Day care surgery under total intravenous anaesthesia where the patient is discharged the same day has made hysteroscopy, a form of minimally invasive surgery, the most frequently performed gynaecological procedure. Aim and objective: Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having dose dependent sedation, analgesic properties and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties have been chosen to compare their efficacy, evaluate the requirement of rescue sedative and/or analgesic, haemodynamic changes and any complication per-operatively for day care hysteroscopic procedures. Methods: 25 patients in each group in the range of age 20 to 55yrs, weight 40-60kg, height 145-155cm, ASA I and II were administered dexmedetomidine (D) 100µg IV or Ketamine (K) 75mg IV both over 10 mins, at the onset of the procedure. Maintenance of anaesthetia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide. Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value <0.0001. The requirement of rescue sedative propofol, midazolam and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p value <0.01, statistically highly significant. Group K had suffered more per-operative complications. Conclusion: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice.