Ketamine-propofol Combination Research Articles

Safety of geriatric patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration with deep sedation: a retrospective study

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also associated with many pathological processes that further increase morbidity and mortality. The ideal sedation protocol for EBUS-TBNA has yet to be determined in geriatric patients. Deep sedation (DS) may increase the safety and performance of the procedure. There are limited studies evaluating the effectiveness and safety of EBUS-TBNA under DS in elderly patients.Methods280 patients who underwent EBUS-TBNA under DS were included in this retrospective study. 156 patients aged 65 years and over (Group 1) and 124 patients under 45 (Group 2) were compared. Demographic data, comorbidities, pulmonary function tests (PFTs), hemodynamic measurements, and peripheral oxygen saturation (SpO2) before the procedure were evaluated. In addition, the duration of the EBUS-TBNA procedure, sedation agents and dosages, recovery time, and complications related to the procedure in the 24 h and applied medications and treatments were recorded.ResultsThere was no difference in body mass index, EBUS-TBNA procedure duration, and recovery time between geriatric and young patients(p > 0.05). The proportion of female patients, pre-anesthesia SpO2, and PFTs were found to be significantly lower in geriatric patients(p < 0.05). ASA classification, frequency of comorbidities, and initial mean arterial pressure were found to be significantly higher in the geriatric group(p < 0.05). The propofol-ketamine combination was the most preferred sedative in both groups. The dose of propofol used in the regimen in which propofol was administered alone was found to be lower in the elderly group (p < 0.05). The increase in the HR was significant in Group 2 in the T4 and T5 periods with respect to T1 when the differences were compared (p < 0.05). As a complication, the frequency of high blood pressure during the procedure was higher in the elderly group (p < 0.05).ConclusionsThe EBUS-TBNA procedure performed under DS was safe in elderly and young patients. Our study showed that the procedure and recovery times were similar in the elderly and young groups. The incidence of temporary high blood pressure during the procedure was higher in the elderly patients. The other complication rates during the procedure were similar in groups. Decreased propofol dose in the regimen using propofol alone has shown us that anesthetists are more sensitive to the administration of sedative agents in geriatric patients, taking into account comorbidities and drug interactions.

Sedation Quality of Low – Dose Ketamine Combined with Dexmedetomidine versus Propofol in Phacoemulsification under Local Anesthesia: A Triple-Blinded Randomized Clinical Trial

Purpose: To compare the hemodynamic effects of low-dose ketamine combined with dexmedetomidine versus propofol in phacoemulsification under local anesthesia. Place and Duration of Study: School of Medicine, Isfahan University of Medical Sciences during 2020-2021. Methods: Sixty patients admitted for cataract surgery were included. Those with history of systemic diseases, insufficient pupil dilation, sensitivity to drugs and uncooperative patients were excluded. Participants were randomly allocated to two groups; group which was administered ketamine with dexmedetomidine (Ketodex) and group which was given ketamine with propofol (Ketofel). Effect on blood pressure, pulse and sedation was recorded. Results: Mean age was 65 ± 9.9 years. Sixty-five were females. Ketodex increased the risk of hemodynamic disorders compared to Ketofel (P = 0.04). The risk of nausea and vomiting was higher in the Ketodex group although not significant. The effect of drug course on heart rate, blood pressure and sedation was significant in both groups (P &lt; 0.05). Neither at baseline, nor in the 1st and 5th minutes of surgery, was the mean arterial pressure (MAP) was significantly different between the two groups. From 10th minute of surgery until the end of surgery and from the beginning of recovery until the 30th minute of recovery, the MAP and pulse rate were higher in Ketofol group. Sedation effect during surgery was higher in the Ketodex group compared to the Ketofol group, and the difference was statistically significant at minutes 10, 20 and 30 of surgery. Conclusion: There is higher effect of sedation and fewer side effects of ketamine-dexmedetomidine combination compared to the ketamine-propofol combination.

Сравнение применения комбинации кетамин-пропофол с моноседацией пропофолом при эндоскопических процедурах в стационаре

Сравнение применения комбинации кетамин-пропофол с моноседацией пропофолом при эндоскопических процедурах в стационаре

Comparison of the Effect of Adding Low-dose Ketamine to Dexmedetomidine and Propofol on the Quality of Sedation and Hemodynamic Response in Children During Upper Gastrointestinal Endoscopy: A Double-blind Randomized Clinical Trial

Background: As endoscopy is an invasive and painful procedure, it is necessary to use a suitable sedative with a minimum dose, especially in children. Objectives: This study aimed to compare the effect of adding low-dose ketamine to dexmedetomidine and propofol on the quality of sedation and hemodynamic response in children during upper gastrointestinal endoscopy. Methods: This double-blind, randomized clinical trial was conducted on 52 children who were candidates for endoscopy in 2 groups, each consisting of 26 patients. In the first group (Ketadex group), infusion of dexmedetomidine (0.7 - 1 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. In the second group (Ketofol group), infusion of propofol (50 - 100 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. Results: The mean blood pressure of children decreased slightly during and after the endoscopic procedure in the Ketadex group than in the Ketofol group (P &lt; 0.05). The recovery time was significantly less in the Ketofol group (41.85 ± 7.03 minutes) than in the Ketadex group (55.12 ± 7.55 minutes; P &lt; 0.001). Conclusions: The addition of the low-dose ketamine to propofol and dexmedetomidine did not result in any significant changes in the level of sedation, the incidence of adverse effects, and the endoscopist’s satisfaction; however, the recovery time was shorter in the propofol-ketamine combination than in the dexmedetomidine-ketamine combination.

EFFECT OF TWO DRUG COMBINATIONS PROPOFOL-KETAMINE AND PROPOFOL-FENTANYL ON HEMODYNAMIC PARAMETERS AND RECOVERY FROM ANAESTHESIA IN TIVA-A COMPARATIVE STUDY

Introduction- Total Intravenous anaesthesia(TIVA) is widely used procedure. We compared the effect of propofol-ketamine combination with propofol-fentanyl combination on hemodynamic parameters and recovery of patients undergoing TIVA. T Aims and Objective- o compare the effect of combination of propofol and ketamine and combination of propofol and fentanyl for TIVA, on hemodynamic parameters and recovery from anaesthesia. Patients aged 20- to 60-year-old, ASA-PS I and II, undergoing elect Material and Method- ive surgeries were selected for the study and were divided into two groups (1 and 2) of 90 each. TIVA was administered in the two groups as- Group-1 Induction- Propofol 1.0mg/kg+Ketamine 1.0mg/kg, iv boluses. Maintenance- Propofol 2.0 mg/kg/h and Ketamine 2.0 mg/kg/h, iv infusion. Group-2 InductionPropofol 1.0mg/kg+Fentanyl 2.0µg/kg, iv boluses. Maintenance- Propofol 2.0mg/kg/h and Ketamine 2.0µg/kg/h, iv infusion. All the patients were mechanically ventilated with 100% oxygen. Neuromuscular blockade achieved with Vecuronium-bromide. Vital-parameters were recorded at regular intervals and DJ Steward recovery score was calculated. Following i Result- nduction, heart rate (HR) increased in Group-1 and decreased in Group-2 and mean blood pressure (systolic and diastolic) increased in Group-1 while it decreased in Group-2. HR and blood pressure(BP) returned towards baseline during maintenance in both the groups. HR and BP increased in both the groups following extubation but gradually returned to baseline. Group-1 scored higher on ventilation, whereas Group-2 scored higher on wakefulness and movement. Though the difference became insignicant post 10 minutes. Both propofol-ketamine and propofol-fentanyl combinations Summary- can be utilized in TIVA for short elective procedures because they offer effective surgical anaesthesia with little strain on hemodynamic parameters, which helps to preserve stability and speed up recovery

A COMPARATIVE STUDY OF HEMODYNAMIC EFFECTS OF INDUCTION DOSES OF PROPOFOL-THIOPENTONE AND PROPOFOL-KETAMINE COMBINATIONS

Objective: We conducted this study to compare the hemodynamic effects of propofol-ketamine combination as induction agents to propofolthiopentone combination. An interventional comparative study was carried out at S Methods: anthiram medical college, Nandyal. 50 ASA 1 and 2 patients in the age group of 18-50 years, undergoing elective surgery under general anaesthesia were enrolled for this study and were randomly allotted into two groups (A and B) of 25 each. Group A was induced with propofol-thiopentone and Group B was given propofol-ketamine combination. The hemodynamic parameters- heart rate, systolic, diastolic and mean arterial pressures were monitored starting from baseline up to 10 minutes. There was a signicant decrease in systolic blood pressure (p&lt;0.05) i Results: n group A at 4 and 7 min compared to group B. There was signicant increase in pulse rate in group A at 1,4,7 and 10 minutes after intubation (p&lt;0.05).Diastolic and mean arterial pressures were comparable in both the groups. Administration of ketamine with propofol was comparatively better in maintainin Conclusion: g the hemodynamic stability after induction as compared to Thiopentone- propofol combination

Comparison of Two Drug Combinations in Total Intravenous Anaesthesia: Propofol-Ketamine and Propofol-Fentanyl

Introduction: TIVA has many advantages over inhalational anaesthesia such as minimal cardiac depression, decreased oxygen consumption, avoids postoperative diffusion hypoxemia, decreases the incidence of postoperative nausea and vomiting etc. This study was conducted to evaluate and compare two TIVA drug combinations using propofol- ketamine and propofol-fentanyl, and to examine the characteristics of induction of anaesthesia, maintenance, and recovery.&#x0D; Method: 34 patients of ASA grading 1,2 and 3 aged between 20 to 65 years of either sex undergoing short surgical procedures were included in the study. According to Comparison of systolic blood pressure of both the groups at intubation time of anaesthesia in group I and group II. Patients in group I received propofol and ketamine intravenously (IV) to induce anaesthesia. For group II, fentanyl and propofol were administered as IV bolus doses. All the results were tabulated and analyzed statistically.&#x0D; Result: Propofol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressures as compared to propofol-ketamine during induction of anaesthesia. Propofol-ketamine combination produced stable hemodynamic during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II.&#x0D; Conclusions: Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anaesthesia with only a few untoward side effects and only minor hemodynamic effects.

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

IntroductionThe combination of different agents used for procedural sedation allows a greater range of desirable effects while minimizing side effects. The ketamine-dexmedetomidine combination (ketadex) and ketamine-propofol combination (ketofol) are successful examples. The purpose of this meta-analysis was to compare the safety and efficacy of ketadex with ketofol used for procedural sedation in pediatric patients. MethodsWe searched Pubmed, Cochrane Controlled Register of Trials, and Embase from inception to June 2022. Studies were independently evaluated for inclusion criteria and exclusion criteria by two reviewers. Outcome measures for safety comparison were the incidence of hypotension, bradycardia, respiratory depression, nausea, vomiting, and agitation; Outcome measure for efficacy comparison was clinicians' satisfaction. In addition, we compared the recovery time of ketadex and ketofol. ResultsNine studies were included in this meta-analysis. Compared with ketofol, ketadex sedation in pediatric patients had lower risk of respiratory depression (RR: 0.51, 95% CI: 0.34–0.76, P = 0.0009). However, ketadex displayed significant effect on recovery time (MD: 8.38 min, 95% CI: 7.55–9.22 min, P < 0.00001). Ketadex had similar incidence of hypotension (RR: 0.95, 95% CI: 0.33–2.67, P = 0.92) and bradycardia (RR: 1.80, 95% CI: 0.64–5.06, P = 0.26) compared to those with ketofol. Clinicians' satisfaction rate of ketadex and ketofol were both high (RR: 0.93, 95% CI: 0.69–1.25, P = 0.62). Also, no significant difference was observed between ketadex and ketofol on the incidence of nausea, vomiting, and agitation. ConclusionsBoth ketadex and ketofol can provide effective sedation and maintain stable hemodynamics. In consideration of good safety profile in respiratory problems, we suggest ketadex is a better option for procedural sedation in pediatric patients.

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies.

Background and objectives: Procedural sedation for bone marrow examination (BME) and intrathecal chemotherapy (ITC) is necessary for pediatric patients with hematological malignancies. There has been no report on adverse events after discharge from the recovery room. This retrospective study evaluated the types and incidences of delayed adverse events among pediatric patients scheduled for BME or ITC under deep sedation in a single center for 3 years. Materials and Methods: The patients were divided into two groups: inpatients (group I) and outpatients (group O). All patients were managed during the procedures and the recovery period. In total, 10 adverse events were assessed; these occurred 2 h (T1, acute), 12 h (T2, early), and 24 h (T3, delayed) after the procedure. The duration of each adverse event was also recorded and was classified as 2 h (D1), 12 h (D2), or 24 h (D3). The data of 263 patients (147 inpatients and 116 outpatients) who met the inclusion criteria were analyzed. Results: The overall incidence of adverse events was statistically significant difference: 48.3% in group I and 33.6% in group O (p = 0.011). The rates of adverse events at T1 and T2 were significantly different between groups I and O (42.8% vs. 11.2% and 7.5% vs. 20.7%, respectively) (p < 0.001). The adverse events were mostly of D1 or D2 duration in both groups. Patients with a higher proportion of ketamine in a propofol–ketamine mixture had a significantly higher proportion of adverse events at T1 (34.6%), as compared with those with a mixture with a lower proportion of ketamine (21.1%) or propofol alone (17.9%) (p = 0.012). Conclusions: The most common adverse events were dizziness or headache; typically, they did not last longer than 12 h. The propofol-ketamine combination with a higher proportion of ketamine seems to produce more adverse events within 2 h after the procedure. Nevertheless, all sedative types appear safe to use without additional management.

The effect of remifentanil on hemodynamic response to laryngeal mask airway insertion in induction of anesthesia with propofol fentanyl or propofol ketamine in cataract surgery

Background. Induction of general anesthesia may cause hemodynamic instability. Remifentanil is often prescribed to suppress the hemodynamic response to anesthesia. The aim of this study was to investigate the effect of remifentanil on hemodynamic response to induction of anesthesia with propofol fentanyl or propofol ketamine and laryngeal mask airway (LMA) insertion. Methods. This double-blind randomized clinical trial study was performed on 44 candidates for cataract surgery in Feyz Hospital, Isfahan, Iran from March to June 2020. Patients were randomly assigned into two groups using random allocation software. The first group received 1 mcg/kg fentanyl and the second group received 0.5 mg/kg ketamine. Also, both groups received 1 mg/kg propofol and 0.5 mcg/kg remifentanil intravenously. Hemodynamic parameters were measured and recorded at study times, and the results were analyzed statistically. Results. The mean age (P=0.199), weight (P=0.050), height (P=0.9), and frequency distribution of gender (0.763) and American Society of Anesthesiologists (ASA) score (0.069) were not significantly different between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in fentanyl group were significantly lower than the ketamine group immediately before LMA insertion, as well as 1, 3, and 5 minutes after LMA insertion (P &lt;0.050). In addition, the mean heart rate (HR) in the fentanyl group decreased significantly at different time (P&lt;0.001), but no significant difference was observed in ketamine group (P=0.056). In addition, the mean HR did not differ significantly between the two groups in any of the follow-up times (P&gt;0.050). Conclusion. Intravenous administration of remifentanil in induction of anesthesia with propofol-ketamine and propofol-fentanyl reduced changes in hemodynamic responses to LMA insertion. This hemodynamic stability was increased by adding remifentanil to the propofol-ketamine combination. Practical Implications. Remifentanil is associated with weakening of hemodynamic responses to LMA insertion in induction of anesthesia with propofol and ketamine or propofol and fentanyl; this effect can be associated with safety in cardiac patients.

Anesthesia induction regimens may affect QT interval in cardiac surgery patients: A randomized-controlled trial.

Background The aim of this study was to investigate the effects on QT interval of the propofol-ketamine combination and the midazolam-fentanyl combination in anesthesia induction for cardiac surgery. Methods Between September 2020 and June 2021, a total of 9 5 c ardiac s urgery p atients ( 80 m ales, 1 5 f emales; mean age: 57±9.1 years; range, 26 to 76 years) were included. The patients were divided into two groups as Group PK (propofol-ketamine, n=50) and Group MF (midazolam-fentanyl, n=45). The 12-lead electrocardiographic and hemodynamic measurements were performed at three time points: before anesthesia induction, after anesthesia induction, and after endotracheal intubation. The measurements were evaluated with conventional Bazett's formula and a new model called index of cardio-electrophysiological balance. Results The evaluated QTc values of 95 patients after anesthesia induction were significantly prolonged with the Bazett's formula and the index of cardio-electrophysiological balance in Group PK (p=0.034 and p=0.003, respectively). A statistically significant QTc prolongation was observed with the index of cardio-electrophysiological balance after laryngoscopy and endotracheal intubation in Group PK (p=0.042). Hemodynamic parameters were also higher in Group PK. Conclusion Our study shows that the propofol-ketamine combination prolongs the QTc value determined by the Bazett's formula and the index of cardio-electrophysiological balance model. Using both QTc measurement models, the midazolam-fentanyl combination has no prolongation effect on QTc interval in coronary surgery patients.

Comparison of Propofol-Fentanyl Versus Propofol-Ketamine Combination as Total Intravenous Anesthesia in Maxillofacial Surgical Procedures – A Prospective Randomized Controlled Study

Background: Total intravenous anesthesia (TIVA) is a technique where drugs are administered intravenously for the induction and maintenance of anesthesia instead of volatile drugs, avoiding some of the drawbacks of inhalation anesthesia providing rapid and complete recovery making it suitable for daycare surgeries. Aim: To compare the intraoperative and postoperative hemodynamic patterns, postoperative recovery time, and unwanted consequences such as post-operative nausea and vomiting (PONV) in various maxillofacial procedures using a combination of two drug regimens, namely propofol-ketamine and propofol-fentanyl. Patient &amp; methods: 40 patients between the age group of 18-40 years of either gender were randomly divided into two groups with propofol-ketamine (group 1, n=20) and propofol-fentanyl (group 2, n=20) who underwent various surgical procedures like cyst enucleation, open reduction and internal fixation (ORIF) of facial fractures, orthognathic procedures such as maxillary or mandibular segmental osteotomy and genioplasty with the procedure lasting 60 to 75 minutes. This study compared the total amount of propofol, time of the infusion, and hemodynamic parameters like mean pulse rate (PR), oxygen saturation level (SpO2), systolic blood pressure (SBP) &amp; diastolic blood pressure (DBP), emergence time &amp; recovery time, undesirable sequels like postoperative nausea and vomiting (PONV) and any other side effects between both the groups. Results were analyzed statistically using an independent t-test and chi-square test. Results: A comparison of two groups revealed a significant rise in systolic blood pressure in group 1 as compared to group 2 and group 2 showed better emergence time &amp; recovery time with fewer incidences of postoperative nausea and vomiting and other side effects. Conclusion: Since the propofol-fentanyl provided significantly good results it can be considered as an alternative to gaseous anesthetic agents in various maxillofacial surgical procedures mentioned in the materials with the surgical procedure lasting 60-75 minutes.

Comparison of the Haemodynamic Response to Laryngoscopy and Endotracheal Intubation with Etomidate versus Propofol-Ketamine and Thiopentone-Ketamine in Lumber Spine associated Surgery: A Randomized Interventional Study

Background: Laryngoscopy and endotracheal intubation is commonly used for securing airway during odynamic disturbances.We aimed to determine the difference in haemodynamic variables during laryngoscopy and endotracheal intubation with Etomidate versus Propofol-ketamine and thiopentone-ketamine as induction agent in elective lumber spine associated surgery. Material and Methods: It was a Prospective randomized comparative interventional study on total 111 patients, aged 25-60 years of either sex with ASA physical status I and II who were randomly allocated into three groups (37in each group). Group A: Received inj. Etomidate 0.3 mg/kg IV, Group B received inj. Propofol 1.5 mg/kg IV + inj. Ketamine 0.5 mg/kg IV, Group C received inj. Thiopentone 3 mg/kg + inj. Ketamine 0.5 mg/kg IV; at induction of anaesthaesia. Haemodynamic parameters (SBP, DBP, MAP, and HR) were noted at baseline, after induction, just before intubation, and 1, 3, 5, 10 and 15 min after intubation. Side effects like myoclonus, post-operative nausea and vomiting (PONV) and hallucinations were also noted. Statistical analysis was performed using ANOVA test and chi-square test (P significant). Results: Hemodynamic parameters were increased in all groups after intubation and was minimum in Group B compared to Group A and C at one min post intubation. Myoclonus and PONV were observed more in Group A than Group B and C (statistically nonsignificant in all three groups). Conclusion: Propofol-ketamine combination is a safe and effective induction agent with better hemodynamic stability as compared to Etomidate and thiopental-ketamine in general anaesthesia. Keywords: Myoclonus, Post-Operative Nausea and Vomiting, Hallucination, Airway

Outstanding Seizure Characteristics With Etomidate and Ketofol

IntroductionElectroconvulsive therapy (ECT) is administered following general anaesthetic induction with methohexital, thiopental, etomidate, alfentanil, remifentanil, propofol or ketamine. One approach for idealizing the induction anaesthesia for ECT is combining two agents (e.g. ketamine-propofol) with synergistic anaesthetic properties and non-additive anticonvulsive and hyperdynamic effects.ObjectivesTo establish any superiority between ketamine-propofol (ketofol) combination and etomidate in terms of seizure characteristics and hemodynamic measures.MethodsWe have combined our previous case series (etomidate vs thiopental) with new data regarding propofol and ketofol. ECT stimulus duration, stimulus frequency, the stimulus charge applied, duration of central seizure time, number of stimulation trials, plus anaesthetic used in the individual sessions were retrieved. A total number of 1092 sessions (239 sessions with etomidate, 233 with thiopental, 275 with propofol, and 345 with ketofol induction) were included in the linear mixed-effects model analysis.ResultsEtomidate was superior in terms of seizure duration compared with thiopental. There was no significant difference in seizure durations between ketofol, propofol and thiopental, however, number of failed stimulation trials within a session increased significantly with propofol use compared with etomidate and ketofol. The required amount of charge (stimulation dosage) was significantly lower when ketofol was used, compared with thiopental. Additionally, within the ketofol sessions only the propofol dose significantly increased the amount of required dose.ConclusionsEtomidate and ketofol displayed certain superiorities in terms of seizure characteristics when used as induction anaesthetics for ECT. Therefore, both etomidate and ketamine used in combination with propofol may be considered to be the gold standards of ECT anaesthesia.DisclosureNo significant relationships.

Abstract No. : ABS3718: Comparison of ketamine-dexmedetomidine versus ketamine-propofol combination for sedation during short duration urological procedure: A randomised study

Background and Aims:The present study aimed to compare safety and efficacy of ketamine-dexmedetomidine (KD) with ketamine- Propofol (KP) for sedation during short-duration urological procedure.Methods:The present study enroled and randomised 60 patients into either of the two groups. In Group KD (n=30) received inj dexmedetomidine 1.0 µ/ kg over 10 minutes intravenously followed by inj. ketamine 1 mg/kg as initial dose followed by 0.25mg/kg in titration. In Group KP (n=30) patients received inj propofol 1mg/kg with inj ketamine 1mg/kg as initial dose followed by the same combination top-up dose 0.25mg/kg in titration. Sedation score, Memorial delirium assessment Scale (MIDS), postoperative pain scores and recovery time were recorded. For Independent-samples, t-test was used and for proportion of significance, Chi-square test was used.Results:Post anaesthesia recovery scores (PARS) were 9.03±0.45 in Group KP and 9.06±0.36 in Group KD, p value= 0.79. No significant differences were observed in the level of sedation, PARS and postoperative pain in both the groups. In Group KD, patients were haemodynamically stable as compared to Group KP. There were no episode of apnea in Group KD as compared 6 episodes in Group KP, (p=0.005). No significant adverse event were reported in both the groups.Conclusion:No differences were observed in sedation score and recovery period in both the groups. Patients in Group KD experienced reduced respiratory depression as compared to Group K. Sedation with Ketamine-dexmedetomidine can be considered as a useful alternative to ketamine-propofol in short urological procedures.

Procedural Sedation Using Two Different Proportions of Ketamine-Propofol Combination in Short Gynecological Procedures: A Randomized Controlled Trial.

Background: Procedural sedation with a combination of propofol and ketamine for short-duration surgeries is a convenient technique of anesthesia as it has a faster recovery avoiding the side effects of general anesthesia. The aim of this study was to compare the sedative and analgesic effects of two different proportions of ketamine and propofol combination in patients undergoing short gynecological procedures.Methods: A randomized double-blind study was conducted in 140 patients posted for elective gynecological procedures with a duration equal to or less than 30 minutes. After premedication of all participants, sedation was induced with bolus administration (0.1 mL/kg) of the study drugs to achieve desired Ramsay sedation score (RSS) of 6, followed by infusion at 0.3 mL/kg/h (Group A, ketamine:propofol in the ratio of 1:4 and Group B, ketamine:propofol in the ratio of 1:2). The adequacy of sedation, volume of drug to induce the patient, time to achieve desired RSS, time for first bolus dose, the total volume of the drugs, hemodynamic variables, awakening time, and side effects were observed.Results: The incidence of movement of lower extremities was found to be significantly lower in the higher concentration ketamine group (Group B, P - 0.028). The volume of a drug for induction and the duration to reach RSS of 6 were significantly lower in Group B with P-values of 0.002 and <0.001, respectively. Hemodynamic variables, awakening time, and side effects were not statistically significant between the two groups.Conclusion: Ketamine-propofol combination in the ratio 1:2 provides better sedation and analgesia with no increased side-effects compared to ketamine-propofol in the ratio 1:4 for short outpatient gynecological procedures.

Safety and Efficacy of KetamineDexmedetomidine versus Ketamine-Propofol Combination for Short-term Sedation in Postoperative Obstetric Patients on Mechanical Ventilation: A Randomised Clinical Trial

Introduction: Prolonged mechanical ventilation in postoperative obstetric patients is an important cause of morbidity and mortality. Choosing intravenous sedation for these patients is challenging, as many of these drugs have unique benefits and adverse effects.There are several options are available like benzodiazepines, propofol, alfa-2 agonist, opioids and ketamine. Usually, a combination of sedatives are used to avoid dose dependent adverse effects. Aim: To evaluate the combination of Ketamine-Dexmedetomidine (KD) and ketamine-propofol for sedation in mechanically ventilated obstetric patients to compare haemodynamic changes. Secondary objectives to assess adverse effects if any, additional opioid (fentanyl) requirement and total length of intensive care unit stay. Materials and Methods: This randomised clinical study was conducted at King George’s Medical University, Lucknow, Uttar Pradesh, India, from May 2018 to August 2019. Total 67 obstetric patients, between 18-45 years of age, requiring postoperative ventilatory support, were included in the study. For sedation, 33 patient received ketamine-dexmedetomidine (group I) combination and 34 patients received ketamine-propofol (group II) combination upto 12 hours of ventilatory support. Target of sedation was to obtain Ramsay sedation scoring between 3-4. Mean Arterial Pressure (MAP) was measured at 0.5 hour, 1 hour, 2 hours, 4 hours, and at every 2 hourly till 12 hours. Pain was assessed using adult non verbal pain score. Adverse effects (tachyarrhythmia, agitation and hypersalivation) were noted. Total length of Intensive Care Unit (ICU) stay was also recorded. Results: Age of patients enrolled in the study ranged from 20 to 37 years, the mean age being 27.09±4.61 years. At baseline mean arterial pressure of patients of group I (103.82±19.26 mmHg) was higher than that of group II (96.74±13.49 mmHg) (p-value=0.085). For the rest of the periods of observation, from 0.5 hour to 14 hour,the MAP of group I remained higher as compared to group II. On intragroup comparison, group II had more fluctuation in MAP than group I. Additional requirement of fentanyl was significantly high in Group II, as compared to group I (32.4% vs. 12.1%). Mean duration of ICU stay was higher in group II, as compared to group I (30.44±7.26 hours vs 22.91±4.03 hours). Conclusion: Ketamine-dexmedetomidine is a better combination for sedation in postoperated obstetric patients on mechanical ventilation than ketamine-propofol as it provides stable haemodynamics, significantly lesser opioid requirement andtotal length of ICU stay.

Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract Background The ideal method for anesthetic management during ERCP varied between deep sedation and general anesthesia with preference for general anesthesia over sedation. Aim of the study Primary aim: The aim of this study will to compare the effects of propofoldexmedetomidine and propofol-ketamine combinations for anesthesia in patients undergoing ERCP regarding the following outcome measures: Hemodynamic changes. Respiratory parameters changes. Propofol requirements. The recovery criteria. Post-operative pain. Secondary aim: To assess the rate of other anesthetic and procedural complications regarding the following outcome measures: Anesthetic complications: Post-procedural nausea and vomiting. Post-procedural cognitive dysfunction or hallucinations. Procedural complications: Bleeding: may occur by sphincterotomy. Duodenal perforation; it is a serious condition but it has a rare incidence and usually requires surgical intervention. Material and methods Patients ERCP, aged 20-50ys old, ASA І-II-III, were randomly allocated in two groups each of which was 25 by a probability method in the form of sequentially numbered, opaque, sealed envelopes (SNOSE) that will be divided in 2 groups (25 envelopes for each group) with random selection for each patient for an envelope. Group-I received dexmedetomidine loading 1µg/kg slow IV over 15min then infused at a rate of 0.5µg/kg/h by syringe pump. Group II received Ketamine 1mg/kg slow IV over 15min then infused at a rate of 0.5mg/kg/h by syringe pump. Both groups received propofol; 1-2mg/kg induction – then 5mg/kg/h IV infusion, 0.5mg/kg boluses guided by hemodynamic parameters, atracurium 0.5mg/kg intubating dose followed by 0.1mg/kg every 20min. Cuffed ETT was inserted and CMV. By the end of the procedure, patients turned supine and reversed by administration of neostigmine (0.05mg/kg) + atropine (0.01mg/kg). Extubation was performed after fulfillment of the criteria of extubation. Conclusion Dexmedetomidine-propofol combination was better than ketamine-propofol combination as regard; hemodynamic parameters (intra- and post-procedural), PONV, cognitive functions and recovery time. Incidence of pain had no clinical significant value between both groups. Total propofol consumption had no clinical significant difference between both groups. Recommendation Dexmedetomidine - propofol combination as TIVA technique for ERCP requires further studies with recommendation to include; different types of patients; geriatric, critically ill and increasing the sample size of patients.

Dexmedetomidine versus Ketamine-Propofol for Sedation of Obese Patients Undergoing Upper Gastrointestinal Endoscopy

Abstract Background Gastrointestinal endoscopy is an uncomfortable and stressful procedure for most patients. Conscious sedation is a common strategy for improving patient comfort during this procedure. Benzodiazepines (gamma-aminobutyric acid (GABA) agonists) such as midazolam have been used for sedation of patients undergoing gastrointestinal endoscopy. The effective dose ranges of such agents differ considerably among patients, making it difficult to achieve stable sedation. Also obesity is a significant health problem that has assumed epidemic proportions. As a result, the number of obese patients requiring endoscopy is increasing. It is relatively unknown how safe the current practices of sedation for endoscopic procedures are in bariatric patients. Therefore, special consideration should be given to these patients Aim of the Work To compare the sedative properties and haemodynamic and respiratory effects of Dexmedetomidine and a Ketamine-Propofol combination (ketofol) in obese patients undergoing Upper GI Endoscopy. Patients and Methods This study was conducted in the endoscopy unit of Ain Shams University Hospital after obtaining approval from the Research Ethical Committee of Ain Shams University. A prospective, randomized controlled clinical trial was found to be the most suitable design in order to achieve the study objectives. Cases were divided into 2 groups using computer generated random list of numbers in sealed opaque envelopes. Results We found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or postprocedure complications. Conclusion In this study, we compared a group of 40 upper GIT endoscopy obese patients (BMI 30-40) who received procedural sedation with either Dexmedetomidine or propofolketamine combination, we found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or post procedure complications.

Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short-Lasting Laparoscopic Procedures.

Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.