Ketamine and propofol: safe for short procedures

Background: Patients who attend the hospital for any form of operative procedure frequently undergo physical or mental pain and agitation. These patients are extremely anxious. It is important to choose the most appropriate form of anesthesia for induction for the analgesia or sedation. This study examined the safety and effectiveness of the Ketamine and Propofol combination technique for short procedures like D and C, MTP, evacuation and marsupilisation of Bartholin’s abscess.Methods: The present observational study was carried out in association with the Gynecology and Obstetrics department and Department of Anesthesiology of PDMMC and hospital, Amravati, Maharashtra, India over a period of 3 months from 1st January to 31st March 2019.Results: In present study, 28 (56%) patients were of 25-40 years age, 14 (28%) patients were of 41-50 years age while 8 (16%) patients were of 51-60 years age. 7 (14%) patients were underweight, 26 (52%) patients had normal BMI, 10 (20%) patients were overweight while 7 (14%) patients were obese. MAP before surgery was 100 ± 12, which decreased to 92±9.2 during operation and increased to 97±19.4 in the postoperative period. Heart rate and arterial SPO2 were not significantly different before, during, and after the operation. Mean VAS score for pain was 5.2±5.1 and the mean Ramsay’s score of sedation was 5.8 ± 0.01. 1 (2%) patient had apnea, 1 (2%) patient had skin reaction, 1 (2%) patient had cough, 1 (2%) patient had agitation while 2 (4%) patient had nausea and vomiting.Conclusions: Ketamine and Propofol combination technique can be recommended for use in the short procedures safely and effectively.

The Effects of Midazolam on Propofol-Induced Involuntary Movement, Pain on Injection and Maintenance Dose / 대한마취과학회지

BACKGROUND: This study examined the effects of midazolam on the propofol-induced involuntary movements, pain on injection, the maintenance dose of propofol, and recovery characteristics. METHODS: In a double-blind, randomized study, 30 children (2 8 yr of age, ASA physical status I or II) undergoing short duration of ENT procedures received midazolam 0.06 mg/kg (Group M) or an equal volume of placebo (Group P) intravenously 3 min before the injection of propofol. At induction of anesthesia an independent anesthesiologist graded the incidence, severity of involuntary movements, and pain on injection. RESULTS: Both groups were similar in age, sex, weight, propofol dose, duration of surgery and anesthesia. Incidence of involuntary movements showed no significant difference between two groups. But, there were significant difference in severity between two groups (P < 0.05). There was significant decrease in pain on injection in group M than group P and no significant differences in open eyes on command, time to extubation and time to discharge. CONCLUSION: Our result demonstrated that midazolam 60 microgram/kg compared with placebo did not reduce the incidence of involuntary movement, but reduced the severity of involuntary movement without delayed recovery. And there was significant reduction of pain on injection in midazolam 60 microgram/kg administration.

Comparison of Propofol and Midazolam for Sedation of Mechanically Ventilated Patients / 대한마취과학회지

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.

Comparison of Propofol and Midazolam for Sedation of Mechanically Ventilated Patients / 대한마취과학회지

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.

On the Usefulness of Intravenous Anesthesia for Patients Undergoing Postoperative Radiologic Examination / 대한마취과학회지

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.

On the Usefulness of Intravenous Anesthesia for Patients Undergoing Postoperative Radiologic Examination / 대한마취과학회지

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.

Sedation and Hemodynamic Stability during Fiberoptic Awake Nasotracheal Intubation: Comparison between Propofol Infusion and Intravenous Boluses of Fentanyl and Midazolam / 대한마취과학회지

BACKGROUND: Crucial to the success of fiberoptic awake tracheal intubation is proper preparation of the patient; this technique will work well in most patients when they are quiet and cooperative and have a larynx nonreactive to physical stimuli. We have attempted to ascertain how well these conditions are achieved with a low-dose infusion of propofol, because of its pharmacological profile. METHODS: Thirty patients, physical status by American Society of Anesthesiologists (A. S. A.) I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (Group P) or intravenous fentanyl 1ug kg-1 and midazolam 0.05 mg kg-1 (Group F). These two groups were compared in terms of hemodynamic profile, sedation score, condition for intubation, coughing and swallowing. RESULTS: There were no statistically significant differences in mean arterial blood pressures according to time between two groups. But in Group F, heart rates were significantly increased in immediately after transtracheal injection of lidocaine, immediately before the fiberoscopy was started, 1, 2 minutes after start of fiberoscopy, compared to Group P (p<0.05). The patients in Group P were more sedated than those in Group F (p<0.05) but there were no significant differences in condition for intubation, reflex of coughing and swallowing, duration of fiberoptic intubation. CONCLUSIONS: We conclude that propofol is useful sedative agent in fiberoptic awake intubation with similar efficacy to midazolam and fentanyl but with more profound sedation and stable hemodynamic profile. These represent significant advantages for severe anxious or hypertensive patients and prolonged procedure of intubation.

The Frequency of Apnea and Loss of Consciousness According to Propofol Dosage in Premedicated Patients with Midazolam / 대한마취과학회지

BACKGROUND: Respiratory depression with high dose of propofol during induction is one of the major complications. We studied the effects of midazolam as premedicant on frequency and duration of apnea and frequency of loss of consciousness in relation to single dose of propofol. METHODS: We selected 194 adult patients who had clear consciousness and no depression of respiration. We allocated patients randomly to control group and midazolam group. In midazolam group, we injected 0.06mg/kg of midazolam intravenously 10min before induction, and in control group, we did nothing. Under mask oxygenation with 100% oxygen, we administered a bolus of propofol (1, 1.5, 2 mg/kg to subgroup 1, 2, 3 respectively) intravenously. The change of respiration and loss of consciousness were observed. RESULTS: The frequency and duration of apnea increased with the dose of propofol in both control and midazolam group. But there were no difference between groups except frequency of apnea with 1.5 mg/kg of propofol. In control group, frequency of loss of consciousness increased with the increasing dose of propofol. But in midazolam group, nearly all the patients was slept without difference by the dose. CONCLUSIONS: Premedication with midazolam reduce the sleeping dose of propofol to induce anesthesia, so the frequency and duration of apnea which is caused by high dose of propofol can be decreased.

Effects of intravenous anesthetics on endotoxin-induced inflammatory responses in rabbits undergoing mechnical ventilation / 中华麻醉学杂志

Objective: To determine the effects of intravenous anesthetics (fentanyl,midazolam and propofol )on inflammatory responses. Method: We employed carrageenan-sensitized endotoxemic rabbit model. Thirty-two New Zealand rabbits were randomly assigned to one of four groups,control group(no anesthetic was used), fentanyl group, midazolam group and propofol group. Different anesthetics were used intravenously for anesthesia induction and maintenance according to the group classification. Meanwhile, all animals were mechanically ventilated, then, 2?g?kg~(-1) lipopolysaccharide(LPS) were injected for endotoxin challenge. Result:In all groups, serum tumor necrosis factor (TNF)activity began to increase at 30 min,reached its maximal level at 60 min,and tended to decrease at 120 min after (LPS) challenge,and the significant increase of TNF activity was associated with development of hypotension. Meanwhile,serum phospholipase A_2(PLA_2)activity began to increase at 60 min and persisted in going up within 2h. Those animals,with continuous infusion of these three different anesthetics and mechanical ventilation,had much lower peak level of TNF and higher mean arterial pressure (MAP)than control levels, but their changes of serum PLA_2 activity had no significant difference from control level. Conclusion: With mechanical ventilation, intravenous infusion of these anesthetics can reduce LPS induced injury in the acute phase of endotoxemia, probably by the inhibition of TNF production.