Propofol Ketamine Research Articles

Comparison of cardiopulmonary effects of propofol, ketamine–propofol and isoflurane anesthesia in the domestic chicken (Gallus gallus domesticus)

ObjectiveTo compare the effects of propofol, ketamine–propofol and isoflurane, at similar anesthetic depth, on cardiopulmonary variables in unpremedictated chickens. Study designProspective, randomized, crossover experimental trial. AnimalsA total of 10 male Leghorn domestic chickens, aged 3 months and body mass 1.4–2.0 kg. MethodsBirds were randomly assigned to each of three anesthetic protocols, 7 days apart: intravenous propofol, intravenous ketamine–propofol or isoflurane. Anesthesia was induced (indicated by loss of righting reflex and tracheal intubation) and maintained with propofol (10 mg kg–1 minute–1, then 1.1 mg kg–1 minute–1), ketamine–propofol (5 mg mL–1 ketamine and 5 mg mL–1 propofol combined; 10 mg kg–1 minute–1, then 1.1 mg kg–1 minute–1) or isoflurane [5% vaporizer setting initially, then end-tidal concentration (Fe′Iso) of 2%] for 65 minutes. Anesthesia was maintained at a similar anesthetic depth based upon positive or negative responses to toe pinch. Heart rate (HR), respiratory rate (fR), noninvasive arterial blood pressure and arterial blood gases were measured during anesthesia. Propofol or ketamine–propofol infusion rates and Fe′Iso required to prevent movement in response to a noxious stimulus and recovery times were recorded. ResultsAnesthesia induction dose was 9.0 ± 0.8 (mean ± SD) and 12.2 ± 0.3 mg kg–1 for propofol and ketamine–propofol, respectively. Propofol and ketamine–propofol infusion rates and Fe′Iso required to prevent movement in response to the noxious stimulus were 0.88 ± 0.14 mg kg–1 minute–1, 0.92 ± 0.14 mg kg–1 minute–1 and 1.45 ± 0.28%, respectively. Cardiopulmonary variables remained clinically acceptable, but ketamine–propofol was associated with a significantly higher HR (p = 0.0001) and lower fR (p = 0.0001). Time to extubation did not differ among treatments. Conclusions and clinical relevanceCardiovascular and respiratory variables were maintained within normal ranges in all treatments. Coadministration of ketamine with propofol significantly reduced the induction and maintenance dose of propofol.

Effects of propofol, ketamine-propofol mixture in pediatric dental patients undergoing intravenous sedation: a clinical study

This study aimed to evaluate the clinical effects, complications (peri- and postoperative), depth of sedation, recovery times, and changes in anxiety levels in paediatric dental patients receiving intravenous sedation with propofol and ketamine–propofol mixtures. This prospective clinical study included 69 healthy children (ASA 1) aged 3–7 years. The patients were assigned randomly to propofol group (n = 23), which received propofol; 1:3 ketofol group (n = 23), which received 1:3 ketofol; or 1:4 ketofol group (n = 23), which received 1:4 ketofol. The bispectral index (BIS) and Ramsay Sedation Scale (RSS) score were recorded at intervals of 5 min to measure the depth of sedation, and vital signs were evaluated. Peri- and postoperative complications and recovery times were recorded. Anxiety levels were also evaluated using the Facial Image Scale (FIS) and changes in saliva cortisol levels (SCLs) before and after the intravenous sedation procedure. The Kruskal‒Wallis test and Wilcoxon signed-rank test were used to determine pre- and posttreatment parameters. Dunn’s test for post hoc analysis was used to determine the differences among groups. Children’s pre- and posttreatment anxiety levels did not differ significantly according to FIS scores, and increases in SCLs were detected in 1:3 ketofol and 1:4 ketofol groups after dental treatment was completed. Compared with those in the other groups, the BIS values of the patients in 1:4 ketofol indicated a slightly lower depth of sedation. The recovery time of the patients in 1:3 ketofol was longer than that of patients in propofol and 1:4 ketofol. The incidence of postoperative complications (agitation, hypersalivation, nausea/vomiting, and diplopia) did not differ among the groups. Ketamine–propofol combinations provided effective sedation similar to that of propofol infusion without any serious complications during dental treatment performed under intravenous sedation. The ketofol infusion increased the anxiety level of paediatric dental patients to a greater extent than the propofol infusion.

Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia

Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.

Intravenous Dexmedetomidine-Ketamine Versus Ketamine-Propofol for Procedural Sedation in Adults Undergoing Short Surgical Procedures: A Randomized Controlled Trial.

Background and objective Moderate to deep sedation is a prerequisite during total intravenous anesthesia for short-duration surgeries, and it can be achieved by using individual drugs or in combination. Our study compared dexmedetomidine-ketamine (DK) versus ketamine-propofol (KP) in terms of sedation, procedural interference, hemodynamics, and incidence of side effects in patients undergoing short surgical procedures. Methods A total of 194 patients scheduled for short-duration elective surgeries were randomly allocated into two groups. Group DK received a loading dose of 1 µg/kg of dexmedetomidine and 1 mg/kg of ketamine followed by a maintenance infusion of dexmedetomidine at 0.3 µg/kg/h. Group KP received a loading dose of 1 mg/kg of ketamine and 1 mg/kg of propofol followed by a maintenance infusion of propofol at 25 µg/kg/h. For procedural interference, a rescueketamine bolus was administered at 0.25 mg/kg. Patients were monitored for the requirement of rescue ketamine bolus, procedural interference, hemodynamics, sedation, recovery time, and adverse effects. Results The procedural interference was higher in group KP than in group DK and the difference was statistically significant (P=0.001). The time to the first rescue bolus was 8.72 ± 4.47 minutes in group KP and 10.82 ± 4.01 minutes in group DK, with a difference of 2.1 minutes (p=0.026). There was no statistically significant difference in the sedation scores between both groups except at time points of six minutes and 15 minutes. Conclusion For short-duration procedures, the DK combination is superior tothe KP combination in terms of procedural interference and time to the first rescue bolus, while both groups were comparable with regard to safety and hemodynamics.

Comparison of hemodynamic stability of propofol ketamine versus etomidate ketamine during induction in peritonitis cases posted for emergency surgery

The aim: The aim of the present study is to evaluate the hemodynamic stability of propofol ketamine versus etomidate ketamine during induction of anaesthesia in peritonitis cases posted for emergency surgery.
 Methods: Sixty patients with peritonitis, posted for emergency surgery under general anaesthesia, were randomly allocated to two groups. Group propofol ketamine (P + K) comprised of 30 patients (n=30) were induced with propofol 1 mg/kg and ketamine 0.75 mg/kg IV. Group etomidate ketamine (E + K) comprised 30 patients induced with etomidate 0.3 mg/kg and ketamine 0.75 mg/kg. The hemodynamic effects of the combination of the drugs in both groups were compared before and after induction.
 Results: The change in saturation (SPO2) and Heartrate between the groups P+K & group E+K before induction and after intubation was similar in both groups. There was a statistically insignificant fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and mean arterial pressure (MAP) in group P+K before and after induction when compared to group E+K.
 Conclusions: The propofol ketamine and etomidate ketamine combinations have a similar haemodynamic profile and are equally effective in maintaining haemodynamic stability during induction and intubation.

Ketamine–propofol for total intravenous anaesthesia in rabbits: a comparison of premedication with acepromazine–medetomidine, acepromazine–midazolam or acepromazine–morphine

ObjectiveTo describe ketamine–propofol total intravenous anaesthesia (TIVA) following premedication with acepromazine and either medetomidine, midazolam or morphine in rabbits. Study designRandomized, crossover experimental study. AnimalsA total of six healthy female New Zealand White rabbits (2.2 ± 0.3 kg). MethodsRabbits were anaesthetized on four occasions, each separated by 7 days: an intramuscular injection of saline alone (treatment Saline) or acepromazine (0.5 mg kg–1) in combination with medetomidine (0.1 mg kg–1), midazolam (1 mg kg–1) or morphine (1 mg kg–1), treatments AME, AMI or AMO, respectively, in random order. Anaesthesia was induced and maintained with a mixture containing ketamine (5 mg mL–1) and propofol (5 mg mL–1) (ketofol). Each trachea was intubated and the rabbit administered oxygen during spontaneous ventilation. Ketofol infusion rate was initially 0.4 mg kg–1 minute–1 (0.2 mg kg–1 minute–1 of each drug) and was adjusted to maintain adequate anaesthetic depth based on clinical assessment. Ketofol dose and physiological variables were recorded every 5 minutes. Quality of sedation, intubation and recovery times were recorded. ResultsKetofol induction doses decreased significantly in treatments AME (7.9 ± 2.3) and AMI (8.9 ± 4.0) compared with treatment Saline (16.8 ± 3.2 mg kg–1) (p < 0.05). The total ketofol dose to maintain anaesthesia was significantly lower in treatments AME, AMI and AMO (0.6 ± 0.1, 0.6 ± 0.2 and 0.6 ± 0.1 mg kg–1 minute–1, respectively) than in treatment Saline (1.2 ± 0.2 mg kg–1 minute–1) (p < 0.05). Cardiovascular variables remained at clinically acceptable values, but all treatments caused some degree of hypoventilation. Conclusions and clinical relevancePremedication with AME, AMI and AMO, at the doses studied, significantly decreased the maintenance dose of ketofol infusion in rabbits. Ketofol was determined to be a clinically acceptable combination for TIVA in premedicated rabbits.

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.

Sedative and analgesic effects of propofol–ketamine versus propofol–fentanyl for emergency department procedures

Background:To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short‐acting intravenous sedative drugs in the field of emergency medicine.Objectives:This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures.Methods:This study was a randomized, double‐blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl–propofol or ketamine–propofol. For data gathering, pre‐procedure, and procedure, modified Aldrete's scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t‐test, chi‐square test, and analysis of variance.Results:Among the participants in this study, shoulder procedure was performed more than other procedures (56.6%). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). “Hypotension and bradycardia” were observed with fentofol and “tachycardia” was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures.Conclusion:Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension.

Asleep DBS under ketamine sedation: Proof of concept

BackgroundDeep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to optimize brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS borders and subdomains based on electrophysiological properties like firing rates and patterns, intra-operative evaluation of therapeutic window, and improvement of lead placement accuracy. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties and interference with clinical testing, resulting in potential impact on surgical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. ObjectiveThis open-label study investigates the use of low-dose ketamine for conscious sedation during microelectrode recordings and lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. MethodsThree anesthetic regimens were retrospectively compared in 38 surgeries (74 MER trajectories, 5962 recording sites) across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). ResultsAll anesthesia regimens achieved satisfactory MER. Detection of STN borders and subdomains by expert electrophysiologist was similar between the groups. Electrophysiological signature of the STN under ketamine was not inferior to either control group. All patients completed stimulation testing. ConclusionsThis study supports a low-dose ketamine anesthesia regimen for DBS which allows microelectrode recordings and stimulation testing that are not inferior to those conducted under awake and propofol-awake regimens and may optimize patient experience. A prospective double-blind study that would also compare patients' satisfaction level and clinical outcome should be performed to confirm these findings.

Impact of ketamine versus fentanyl continuous infusion on opioid use in patients admitted to a surgical-trauma intensive care unit.

Ketamine has been shown to decrease opioid utilization as an adjunct, but limited evidence is available on ketamine as a primary analgesic strategy. A retrospective chart review. Mechanically ventilated adult patients (≥18 years) in the surgery-trauma intensive care unit (STICU) with continuous infusion ketamine or fentanyl with concomitant propofol for at least 12 hours were screened for inclusion. The final analysis included 22 patients in the ketamine/propofol (KP) group and 24 patients in the fentanyl/propofol (FP) group. Patients in the STICU received KP or FP continuous infusions. The primary outcome compared opioid requirements between both groups during mechanical ventilation. The median opioid requirement during mechanical ventilation was significantly higher in the FP group compared to the KP group (median 1,392 milligrams of morphine equivalents (MMEs) [interquartile range (IQR) 709.5-2,292] versus 206.3 MME [IQR 87-510], p < 0.001). After extubation, there was no difference in opioid utilization. Patients in the KP group spent less time at goal Critical Care Pain Observation Tool compared to the FP group (median 77.6 percent, IQR [71.9-85.2] versus 88.9 percent, IQR [76.9-97.4], p = 0.003). The proportions of patients developing adverse effects were not significantly different between the two groups. Among critically ill mechanically ventilated patients in the STICU, continuous ketamine resulted in signifi-cantly less opioids during mechanical ventilation. Further studies with a larger sample size are needed to assess the ap-propriate dosing strategy for ketamine to produce adequate analgesia when used as a primary analgesic in mechanically ventilated patients.

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.

Comparing Propofol-Ketamine and Propofol-Fentanyl as Procedural Sedation and Postoperative Analgesia for Total Intravenous Anaesthesia in Adult Patients Undergoing Short Surgical ProceduresA Randomised Clinical Study

Introduction: Total Intravenous Anaesthesia (TIVA), an immensely popular procedure of recent times is most often conducted using propofol as the main anaesthetic agent. Ketamine or fentanyl has also been regularly used to compliment with their analgesic action, which propofol lacks. Aim: To compare the induction characteristics, maintenance of anaesthesia, awakening and recovery characteristics while performing TIVA with either propofol-ketamine or propofol-fentanyl combinations. Materials and Methods: This randomised, single blinded study was conducted, from March 2020 to August 2021, in a tertiary care centre of Kolkata, India. Total of 76 patients of either sex, aged between 18-45 years with an American Society of Anesthesiologists (ASA) physical status I and II, who were posted for short surgical procedures, with a duration of surgery less than 30 mins were equally divided into two groups. Group A received propofol ketamine (1:1), prepared by mixing 4 mL ketamine (50 mg/mL) with 20 mL of 1% Propofol (10 mL/kg), while group B received propofol-fentanyl solution (1:1) was prepared by mixing 4 mL (50 µg/mL) of fentanyl with 20 mL of 1% propofol (10 mg/mL). Induction was done with ketamine 10 mg/ kg+propofol 1 mg/kg in group A and fentanyl 1.5 µg/kg+propofol 1.5 mg/kg while maintenance of anaesthesia was achieved with continuous infusion of the prepared solutions for either group respectively at a rate of around 20 mL/hour or more, as per required to maintain the Ramsay Sedation Scale (RSS) score of 6. Intraoperative haemodynamic parameters, including respiratory rates, awakening time, recovery time and the possible the side effects were recorded at regular intervals. Student’s t-test was used for quantitative data and Chi-square test for qualitative data. A p-value of less than 0.05 was considered statistically significant. Results: Patients of group B developed significantly more incidents of bradycardia (20 in group B and 3 in group A) and hypotension (28 in group B and 2 in group A). Respiratory depression was also significantly more in group B (p-value&lt;0.005).However, recovery, awakening, VAS score and other side effect profiles were all comparable in the two groups. Conclusion: Propofol-ketamine provides equipotent analgesia with better haemodynamic control and minimal side effects in comparison to propofol-fentanyl while used in TIVA for adult patients undergoing short surgical procedures.

Comparison of ketamine–propofol (ketofol) versus midazolam–fentanyl for procedural sedation and analgesia in emergency care department: An open-label randomized controlled study

Comparison of ketamine–propofol (ketofol) versus midazolam–fentanyl for procedural sedation and analgesia in emergency care department: An open-label randomized controlled study

Comparison between Rocuronium and Atracurium Effect on Blood Pressure during General Anaesthesia in Baghdad Hospital

This study was aimed to assess the blood pressure influence of rocuronium drug under general anesthesia and compares it with atracurium drug. The study recruited 50 adult patients, divided in to two groups the rocuronium drug groups which included 25 patients and atracurium drug group which included 25 patients, age ranged from (18-60 years) of both sexes who were (ASAI and ASAII) patients undergoing (elective surgeries) in Baghdad education hospital during the period from (October 2019 to March 2020). Anesthesia was induced with using I.V. propofol drug (1.5-2.5 mg/kg), ketamine drug (0.5 mg/kg) or (2-3 mg/kg) propofol drug. For the endotreacheal tube, and facility of intubation injection muscle relaxation the rocuronium drug (0.6 mg/kg) or atracurium drug (0.5 mg/kg), for maintenance rocuronium drug (0.1-0.2 mg/kg). 60 sec. was used after administration of the relaxant, attempt of intubation. Next intubation, lungs were mechanically ventilated, monitored, blood pressure recorded and MAP after five minutes and every five minute for 15 minutes. The resulting P-value of MAP in Rocuronium drug groups and Atracuruim drug group at pre-operative was 0.811 which was non-significant (P&gt; 0.05). While at induction it was 0.309 which was also non-significant (P&gt; 0.05). After 1min it was 0.574 which was non-significant (P&gt; 0.05). After 5min it was 0.321 which was non-significant. After 10 min it was 0.954 which was non-significant (P&gt; 0.05). The blood pressure effected from rocuronium drug and atracurium drug are different under general anesthesia. The Atracurium drugs has less marked change in MAP. In healthy patients it maybe not be of importance, nevertheless it could be nonessential in patients with preexisting cerebral, cardiac diseases, hypertension or the elderly, but Rocuronium drug has a marked change in MAP. This could be cautiously in the patients with preexisting cardiac or cerebral pathology or elderly or hypertension. In conclusions the MAP was increased at induction of rocuronium drug and was decreased at induction of atracurium drug in this study.

An analytical study of Comparison between Ketamine - Dexmedetomidine versus Ketamine - Propofol for Sedation in Children Undergoing Minor Cardiac Procedures in a Cardiac Catheterization Laboratory

Background: The management of children with heart diseases has been a major challenge for cardiac anesthetists. The anesthetic technique to be used should be easy, safer and provide cardiac stability throughout the operation. So cardiac interventionist prefer deep sedation with the patient breathing spontaneously and painlessly in the room. Propofol, Ketamine along with other combinations drugs have been used worldwide by cardiac anesthetists to achieve these goals. We carried out this study to evaluate the combination drugs for pediatric cardiac surgeries which are Ketamine – Dexmedetomidine (KD) and Ketamine – Propofol (KP). Methodology: This study was conducted in the Department of Cardiology. A total number of 80 cases were selected, 40 from each comparative groups of Ketamine – Dexmedetomidine (KD) and Ketamine – Propofol (KP). Patient data was categorized into age, sex, procedure done and recovery time, analgesic boluses required and hemodynamic parameters during the surgery. Results: Mean age in KD group was 5.24 ± 1.25 years and in KP group was 4.95 ± 1.86 years. There were 24 males (60%) and 16 females (40%) in KD group and 22 males (55%) and 18 females (45%) in KP group. Most common procedures done in both the groups was ASD for device closure done in 12 patients (30%) in KD group and 13 patients (32.5%) in KP group. There was significant difference between the mean recovery time and number of ketamine boluses consumption in both the groups. (p&lt;0.05) Heart rate was significantly lower in KD group at 5, 10, 15 and 20 min post induction when compared to KP group. No statistically significance was found in difference between the Mean Respiratory rate and MAP. Conclusion: Our study concludes that the use of KD combination is relatively safe, practical alternative, we did not find any hemodynamic or respiratory effects during the cardiac procedures but there was some delayed recovery.

English

BACKGROUND Ketamine and propofol are one of the commonly used drugs for induction of general anaesthesia. Ketofol, is the combination of ketamine and propofol in varying concentrations. Due to the paucity of information in the literature regarding comparison of different combinations of ketofol for use as an induction agent, we intend to study the various doses of propofol ketamine combination in view of its haemodynamic stability and its relevance to speed of induction as well as side effect profile. METHODS This is a double blinded randomised controlled trial study. 60 patients posted for elective surgery under general anaesthesia were selected. They were randomly allotted to three groups with 20 patients in each group. Group 1 received ketofol in the ratio of 1:1, group 2 in the ratio of 1:2, group 3 in the ratio of 1:3. The time from the start of injection till the loss of verbal command, induction time, was noted. Mean arterial pressure, incidence of apnoea, awareness, hallucinations and post-operative nausea and vomiting (PONV) were noted. RESULTS Induction time was fastest in group 3 followed by group 2 followed by group 1. It was statistically significant. Mean arterial pressure (MAP) was comparable in all the three groups at different time intervals except at 5 minutes after induction, the fall in group 3 was significant. The change in MAP as compared to baseline in group 1 and 2 in different time intervals was not significant. But the fall in MAP was significant as compared to baseline in all the different time intervals in group 3. There was no reported incidence of apnoea, awareness and hallucinations in all the three groups. There were two reported cases of PONV in group 1, one in group 2 and zero in group 3. CONCLUSIONS Ketofol with the maximum propofol and least ketamine combination has the fastest induction time. Ketofol in the combination of 1:1 and 1:2 offers more haemodynamic stability as compared to 1:3 combination and ketofol has minimal side effects. KEY WORDS Ketofol, Different Combinations, Induction Time, Haemodynamic Stability

Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)

ABSTRACT Background Cirrhotic patients are more vulnerable to sedation-related complications than the general population, and there is no consensus on sedation during endoscopic procedures for these patients, whose numbers are increasing globally. Our study compared the efficacy of sedation, hemodynamic, respiratory effects, the incidence of side effects, and patient and endoscopist satisfaction with dexmedetomidine-ketamine versus propofol-ketamine during upper gastrointestinal endoscopy (UGIE) in hepatic patients with Child-Pugh classification A & B. Patients and Methods Seventy adult hepatic patients with Child-Pugh classification class A and B scheduled for UGIE were randomly assigned to one of two groups: The ketamine/dexmedetomidine (KD) group received an IV loading of 1 mg/kg ketamine and 1 µg/kg dexmedetomidine over 10 minutes, followed by 0.1 mg/kg/hr ketamine and 0.1 µg/kg/hr dexmedetomidine maintenance. Ketamine/propofol (KP) group received an IV loading of 1 mg/kg ketamine and 1 mg/kg propofol over 10 minutes, followed by 0.1 mg/kg/hr ketamine and 0.1 mg/kg/hr propofol. Heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2) were measured every 5 minutes (min) until the procedure was completed. The time required to reach the target Ramsay Sedation Score (RSS) (3–4) which is called the induction time, the time required to recover (the recovery time), and the occurrence of side effects were all recorded. The mini-mental state examination (MMSE) at baseline and 2 hours after recovery were measured. Results Demographic data showed no significant differences between the two groups. HR changes in the KD group were significantly lower than in the KP group at T1 (after the loading dose), T2 (after the endoscopy was inserted), and at all time points until the procedure was completed. MAP values were lower in the KD group compared to the KP group, but this difference was not statistically significant. Induction and recovery times were longer in the group (KD) than in group (KP), with (8.00 ± 1.26 min in the group (KD) vs 3.00 ± 1.14 min in the group (KP) for induction and (19.00 ± 1.53 min in the group (KD) vs 9.00 ± 1.41 min in the group (KP) for recovery. The prevalence of oxygen desaturation was higher in the group (KP) than in group (KD) (“9” pts in the group (KP) vs “3” pts in the group(KD)) (KD). However, unwanted movements were statistically more common in group KD than in group KP (6 patients versus two patients, respectively). Baseline MMSE and MMSE at PACU values were comparable within and between the two groups. The levels of satisfaction among patients and endoscopists were comparable in both groups. Conclusion The dexmedetomidine/ketamine combination is as effective as the propofol/ketamine combination in terms of sedation efficacy, with more hemodynamic and respiratory stability, but it has longer induction and recovery times with comparable results in terms of ketamine bolus consumption, MMSE scores after recovery, and patient and endoscopist satisfaction.

Ketamine- Propofol or Fentanyl- Propofol intravenous infusion a better combination for short surgical procedures in paediatric patients, a comparative study

Ketamine- Propofol or Fentanyl- Propofol intravenous infusion a better combination for short surgical procedures in paediatric patients, a comparative study - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2018.0072, Indian Journal of Clinical Anaesthesia-Indian J Clin A

Propofol‐cetamina versus dexmedetomidina‐cetamina para sedação durante endoscopia digestiva alta em pacientes pediátricos: estudo clínico randomizado

Background and objectivesDay‐case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes. MethodsWe enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg‐1 in addition to either propofol (1 mg.kg‐1) or dexmedetomidine (0.5 μg.kg‐1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored. ResultsThere was no significant difference in hemodynamics between the groups. The Propofol‐Ketamine (P‐K) group showed significantly shorter recovery times than the Dexmedetomidine‐Ketamine (D‐K) group (21.25 and 29.75 minutes respectively, p <0.001). The P‐K group showed more oxygen desaturation. Eleven and six patients experienced SpO2 <92% in groups P‐K and D‐K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D‐K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P‐K group, respectively (p=0.001). The P‐K group showed less post‐procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction. ConclusionsThe P‐K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D‐K combination showed less need for additional doses. Registration numberClinical trials.gov (NCT02863861).