Ketamine-propofol sedation in circumcision / Sedação com cetamina-propofol em circuncisão

ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050).CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

RESUMOJUSTIFICATIVA E OBJETIVO: Comparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina-propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré-medicadas com midazolam-cetamina-atropina programadas para procedimentos de circuncisão.MÉTODOS: 60 crianças, estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo-cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05 mg kg-1 + cetamina 3 mg kg-1 + atropina 0,02 mg kg-1 por via intramuscular, na presença dos pais na área de intervenções pré-operatórias. A indução foi realizada com propofol-cetamina no Grupo I ou cetamina isolada no Grupo II.RESULTADOS: Nas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial (p > 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p < 0,050).CONCLUSÃO: Cetamina-propofol (cetofol) proporcionou melhor qualidade de sedação e estabilidade hemodinâmica que cetamina isolada em cirurgias pediátricas de circuncisão. Não foram observadas complicações significativas durante a sedação nos dois grupos. Portanto, cetofol parece ser um método de sedação eficaz e seguro para procedimentos de circuncisão.

Effect of Ketamine Pretreatment on Injection Pain and Hemodynamic Changes during Anesthesia Induction with Propofol / 대한마취과학회지

BACKGROUND: Propofol is useful agents for anesthesia induction and maintenance, but pain on injection and possible hypotension are a commonly encountered problems during induction. Meanwhile, ketamine has potent analgesic and sympathomimetic effect. Therefore, we evaluated the effect of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. METHODS: Premedicated one hundred and twenty ASA physical status I or II patients scheduled for elective surgery were randomly allocated into one of four groups (group 1; propofol only, group 2, 3, 4; pretreatment with 25%, 50%, 75% dose of hypnotic ED50 of ketamine, respectively) groups. Intensity and frequency of injection pain, mean arterial pressure and pulse rate were checked for evaluation of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. RESULTS: Incidence of pain on injection was significantly reduced in group 2,3 and 4 compared with group 1. Group 2 and 3 showed more stable hemodynamic changes than Group 1 and 4. CONCLUSIONS: 25-50% of hypnotic ED50 of ketamine (0.17-0.33 mg/kg) pretreatment reduced pain on injection and hemodynamic changes during propofol induction significantly.

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.

Dose Response and Hypnotic Interaction of Propofol and Ketamine for Anesthesia Induction in Korean / 대한마취과학회지

BACKGROUND: Both propofol and ketamine are useful hypnotics for induction of anesthesia, and the combination of propofol and ketamine has been used for total intravenous anesthesia. The aim of this study was to evaluate the dose response of propofol, ketamine and combination of these drug, and determine possible interaction between two drugs in patients. METHODS: The effect of ketamine on the dose response curve for propofol was studied in unpremedicated 165 ASA physical status I or II patients who were scheduled for elective operation. As an endpoint of hypnosis, ability to open eyes on verbal command was checked. Dose response curves for propofol and ketamine were determined with a probit procedure and their type of pharmacologic interaction was determined by fractional and isobolographic analysis. RESULTS: At the hypnotic endpoint, the ED50s were 1.13 mg/kg propofol, 0.66 mg/kg ketamine, and the ED95s were 1.67 mg/kg propofol, 1.09 mg/kg ketamine. The type of interaction between two drugs for hypnosis was found to be additive and ketamine was 1.7 times potent than propofol as an equieffective dose of hypnosis. CONCLUSIONS: The type of interaction between propofol and ketamine for hypnosis was additive.