The Application of Total Intravenous Anesthesia & Propofol-N2O Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: According to the increasing rate of cesarean section, the efforts of seeking safer and more satisfactory obstetric anesthesia techniques have been continued. Propofol, 2,6 di-isopropyl phenol, is a relatively new intravenous anesthetic agent and has been used for induction and maintenance for total intravenous anesthesia (TIVA). Authors examined the anesthetic technique using following anesthetics combinations; N2O-propofol, fentanyl-propofol, ketamine-propofol and made comparison of these ones for intraoperative hemodynamic stability, maternal and fetal safety. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for cesarean section were randomly allocated into three groups, group N (propofol-N2O, n=20), group F (propofol-fentanyl, n=20), group K (propofol-ketamine, n=20). We checked the changes of blood pressure and heart rates during operation, anesthetic induction time, neonatal status (Apgar score, umbilical vein blood gas analysis), presence of intraoperative awareness and recovery time. RESULTS: No significant differences in intraoperative hemodynamic changes, induction time and baby status. Total propofol dosages were greater in group N than group K (p<0.05) and maternal recovery time was prolonged in group K than group N or F (p<0.05). CONCLUSIONS: Anesthetic management using propofol-N2O or propofol-fentanyl or propofol-ketamine for cesarean section would provide satisfactory anesthesia without significant adverse effects to both mother and fetus.

Low-dose Ketamine or Fentanyl as Analgesic Adjuvants for Intravenous Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.

Low-dose Ketamine or Fentanyl as Analgesic Adjuvants for Intravenous Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.