Monika Gupta

Abstract

Introduction: Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. Materials and Methods: A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation. Results: The supplementation dose required was significantly higher in propofol group (800mg) as compared to ketofol group (20mg) (p=0.00). Also, the fall in SBP and DBP was significantly less in ketofol group than propofol group (p Conclusion: Ketamine-propofol combination in 1:2 ratio in a single syringe as ketofolis better alternative to propofol in providing sedation and analgesia with better haemodynamic stability, for outpatient brachytherapy procedure in cancer cervix patients. Keywords: Brachytherapy, Ketofol, Propofol.

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Abstract

Introduction and Aims: With the increased emphasis on early discharge after surgery, rapid recovery and early ambulation and cost effectiveness, use of short acting drugs like propofol, ketamine and fentanyl along with Bispectral Index (BIS) which allows titration of hypnotic drugs doses and may promote earlier awakening, we conducted this study to explore effectiveness of combinations ketamine-propofol and fentanyl-propofol in day care urological surgery guided by BIS. Materials and Methods: After ethical approval and informed consent 140 patients scheduled for minor urological procedures on day care basis were randomised into two equal groups receiving ketamine-propofol and fentanyl-propofol combinations, to primarily observe haemodynamics, respiratory parameters, optimum sedation guided by BIS and recovery time in terms of Modified Aldrete Score (MAS) and secondarily total propofol consumption and side effects. Results: Patients remained haemodynamically stable in group ketamine-propofol after induction while in group fentanyl-propofol there was significant fall in heart rate up to nine minutes after induction and blood pressure remained significantly low up to fifteen minutes. There was significant fall in respiratory rate and oxygen saturation but significantly early recovery with fentanyl with no significant difference in the incidence of side effects of apnoea, hypotension, bradycardia and nausea-vomiting and hallucination between the groups. Conclusion: Ketamine-propofol combination produces rapid anaesthesia with stable haemodynamics while fentanyl-propofol combination allows faster awakening and reduces the length of stay in the post-anaesthesia recovery room. BIS monitoring optimize intraoperative condition and leads to significantly early recovery for faster home readiness in the ambulatory surgery. Keywords: Day care surgery, Bispectral index, Modified aldrete score, Propofol, Ketamine, Fentanyl.

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