You are on page 1of 8

• • •

Int J Crit Illn Inj Sci > v.2(1); Jan-Apr 2012 > PMC3354371

Int J Crit Illn Inj Sci. 2012 Jan-Apr; 2(1): 17–20. doi: 10.4103/2229-5151.94890 PMCID: PMC3354371

Comparison of ketamine with fentanyl as co-induction in propofol anesthesia for short surgical procedures
Ritu Goyal, Manpreet Singh,1 and Jaiprakash Sharma2 Author information ► Copyright and License information ► Go to:

Abstract
Background and Objective:
A prospective randomized control study was conducted to compare and evaluate quality of anesthesia with ketamine or fentanyl as co-induction with propofol.

Materials and Methods:
Sixty ASA I or II, 18–50 year old patients who were scheduled for minor surgeries of short duration (<30 min anticipated duration) were selected. The patients were randomly allocated to group I and group II comprising 30 patients each. The patients of group I were given ketamine injection 0.5 mg/kg and group II patients fentanyl injection (1.5 μg/kg) as co-induction agent. Two minutes later, induction of anesthesia was given with inj propofol (2.5 mg/kg) and appropriate-sized laryngeal mask airway was inserted. The anesthesia was maintained with 60% N2O in O2 and intermittent bolus of inj propofol (0.5 mg/kg) after observing significant changes in the heart rate, blood pressure, lacrimation, sweating, and abnormal movements.

Results:
There was significant decrease (P<0.05) in the pulse rate, systolic and diastolic blood pressure at 1, 3, and 5 min in group II (fentanyl group) whereas the change was insignificant (P>0.05) at 10 min.

Conclusion:

oxygen saturation. as the co-induction agent. induction of anesthesia was done with inj.[1] Ketamine in subanesthetic dose has also gained attention as an alternative analgesic as well as the co-induction agent. capnography. The patients of group I received intravenous ketamine injection 0.2 mg and injection Ondansetron 0. Most often fentanyl has been used as co-induction agent with propofol. The patients having hypersensitivity with fentanyl. psychiatric disorders.It was observed that ketamine as premedicant was better than fentanyl with respect to hemodynamic stability and caused less adverse effects intraoperatively and postoperatively. propofol anesthesia Go to: INTRODUCTION Recently. The patients with history of hypertension. the concept of co-induction has been proved better in various anesthetic procedures. ketamine. All patients were asked to fast for 8 h before proposed time of surgery. Keywords: Fentanyl. noninvasive blood pressure. and temperature (using Datex AS5 monitor®). Two minutes later. an appropriate-sized laryngeal mask airway (LMA) was inserted with a classic technique by an experienced anesthesiologist and anesthesia was . The drug was stopped as soon as patient could not count and it was further confirmed by asking the patient to open his eyes. propofol 2. aged between 18 and 50 years of either sex. sixty patients of ASA I or II. All patients received injection glycopyrrolate 0.5 mg/kg and the patients were asked to count numbers during induction. pulse rate. Go to: MATERIALS AND METHODS After approval from departmental ethical committee. The random numbers from computer generated random tables were written in the chits and one of the anesthesiologist who was blinded to the groups picked up the chit (using the chit-inbox technique). propofol.[2] The aim of this study was to compare ketamine with fentanyl as premedicant in propofol anesthesia with respect to hemodynamic changes and intraoperative or postoperative adverse effects. hepatic or renal disease. convulsions. The patients were randomly allocated and divided in two groups according to drug combination they received.5 μg/kg. Informed consent was obtained from all patients. and having any narcotic addiction were excluded from the study. undergoing minor surgeries (anticipated duration of surgery <30 min) were randomly selected for this prospective double blind study.5 mg/kg and group II patients received fentanyl injection 1. Immediately. The patients were shifted to the operation theatre and an 18 G intravenous cannula was inserted at dorsum vein of left hand and ringer lactate was started. Intraoperative monitoring included ECG (continuous). and ketamine were also excluded from the study.1 mg/kg intravenously 15 min prior to induction. The rationale behind co-induction is that drug combination produces desired effects in more appropriate and balanced manner with fewer side effects that can be observed by using single drug.

incidence of laryngeal spasm. and arterial oxygen saturation at 1. The parameters recorded were systolic and diastolic blood pressure. At 80% power (α=0. and delirium) and awareness during procedure were noted. (nausea. Top up doses of propofol (intermittent 0. recovery time. we decided to recruit a total of 30 patients per group. 5. . Statistically. incidence of apnoea. 3. Table 1 Demographic profile The types of surgical procedure were similar in two groups [Table 2]. This prospective power analysis was based on pilot cases and the previous literature. sweating.4] To allow the potential dropout. Postoperatively. and intraoperative adverse events were compared using the Chisquare test and student's t-test was used for comparison of recovery time.05). and 10 min after induction. The temperature monitoring was done intraoperatively via nasopharyngeal route (Datex AS 5®). it was calculated that 30 patients in each group would be sufficient for the present study. and sex in both groups were statistically comparable [Table 1]. where number of LMA insertion attempts increased to more than 2. The nausea vomiting. Go to: RESULTS The demographic profile with respect to age. respiratory rate.5 mg/kg bolus) were administered when there were more than 20% changes in the baseline heart rate and blood pressure or there was lacrimation. The patients. were excluded from the study. the mean age. or abnormal movements.05 was considered as significant. mean weight. The Wilcoxin rank sum test was used for continuous variables and P-value of <0.[3. and mean pulse rate. The LMA was removed and patient was extubated at completion of surgery and the patients were given postoperative oxygenation by the facemask. and delirium were monitored for first 4 h in postoperative room and subsequently in next 24 h. mean systolic and diastolic blood pressure. vomiting. weight. adverse effects. dizziness.maintained with 60% N2O in O2. dizziness. pulse rate.

time. Table 3 Intraoperative adverse effects Awakening time (spontaneous eye opening) and recovery time (when patient was able to answer simple questions such as name. and place) were statistically insignificant in both groups [Table 4].66% patients of both groups. date of birth. Table 4 Recovery. None of the patients experienced laryngeal spasm and pain during procedure [Table 3]. awakening. Table 5 Postoperative complications . Ten percent patients of group II had felt nausea. Four patients of Group I and 1 patient of group II felt dizziness. age.05). Majority of patients of both groups had pleasant experience of anesthesia [Table 5]. time.Table 2 Types of surgeries Pain due to propofol injection and presence of abnormal movements were statistically insignificant (P>0. and mean total propofol doses There was no complication observed in 86.05) in both the groups while incidence of apnoea was more in group II (P<0.

3. Four patients in group I and one in group II experienced dizziness whereas no patient in either group complained of delirium or awareness during procedure. 3. 3. 5 and 10 minutes Figure 3 Pulse Rate in two groups at 1. hemodynamic variables were also compared at specific intervals after induction. but no episode of vomiting was recorded. three patients in group I and two patients in group II judged anesthesia as unpleasant.4] Past studies have found that combinations of midazolam with thiopental. There was no statistically significant difference in both the groups [Figures [Figures11–3]. 3. and 5 min in group II but not at 10 min. and fentanyl are synergistic. Figure 1 Mean Systolic Blood Pressure in two groups at 1. Go to: DISCUSSION Propofol is widely used as an induction agent during general anesthesia. methohexital. At discharge.[3. while remaining 27 patients in group I and 28 in group II found their experience of anesthesia pleasant. propofol. the effects or adverse effects result cannot be predicted from the knowledge of the dose requirements of individual agents. When combinations of intravenous anesthetic agents are given to patients. there was significant higher reduction in the mean pulse rate at 1. Mean diastolic blood pressure also showed a significant higher reduction in diastolic blood pressure at 1 and 3 min that became statistically insignificant at 5 and 10 min. 5 and 10 minutes Figure 2 Mean Diastolic Blood Pressure in two groups at 1. Similarly. Only four patients in group II complained of nausea. but at 10 min it was insignificant. There was statistically significant higher reduction in mean systolic blood pressure intraoperatively in group II at 1 and 3 min.Intraoperatively. alfentanil. 5 and 10 min The postoperative complications were also observed.[5] In .

Our results were comparable to other studies. This study was conducted to compare ketamine with fentanyl as premedicant in propofol anesthesia with respect to hemodynamic and intraoperative or postoperative adverse effects. muscarinic. when patient was able to answer simple questions such as name. After 10 min. was significantly higher in group I patients. in whom ketamine was administered. The incidence of apnoea was significantly high in patients who received fentanyl as premedicant. and 5 min. but the recovery was faster where fentanyl was administered. The incidence of apnoea and respiratory depression is also less with ketamine. This may be due to cardiostimulant effect of ketamine that in subanesthetic doses may balance the cardiodepressant pressure effects of propofol. Ketamine. 3. in subanaesthetic doses has recently gained more attention as an analgesic for total intravenous anaesthesia. was longer in group I. time. being a cardiostimulant drug.contrast. and place. showed insignificant changes in hemodynamic. ketamine has been found to be additive when combined with midazolam or thiopental using loss of response to verbal command as the end point. Pharmacological targets of ketamine are NMDA receptors. This may be attributed to the indirect action of ketamine that acts sympathetically on sinus node. In addition. a powerful analgesic. ketamine. Similarly. opioid receptors. the time taken when patient opened eyes on verbal commands. the patients.[2] In this study. The patients of group II in which fentanyl was administered. It also possesses local anaesthetic properties with a direct inhibitory action on dorsal horn neurons of lamina I and lamina V. that is. To conclude. the mean systolic and diastolic pressure and pulse rate were reduced significantly at 1.[6–9] where fentanyl was used for propofol anesthesia. This was attributed to fentanyl that causes cardiovascular depression. is better premedicant than fentanyl with respect to hemodynamic stability and adverse effects. age. that is. the recovery time. date of birth. and voltage sensitive Ca++ channel. The awakening time. ketamine premedication with propofol anesthesia attenuated the hemodynamic depression without causing any significant apnoea. it was observed that there was no significant change in hemodynamic parameters in the ketamine group. there was no unpleasant emergence phenomenon reported in any of the patients of any group. Go to: REFERENCES . In addition. Go to: Footnotes Source of Support: Nil Conflict of Interest: None declared. The pain on propofol injection was similar in both the groups and the difference was statistically insignificant between two groups.

Koning GH. 1992. Additive interactions between propofol and Ketamine when used for anesthesia induction in female patients. [PubMed] 2. Plummer J. propofol and alfentanil. Comparison of propofolfentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures. [PubMed] 6. 2001. The influence of fentanyl vs. 1993. Guit JB. 1991. Anaesthesia. Short TG. Coster ML. Tosun Z. Short TG. Compaison of Propofol with Propofol-ketamine combination in pediatric patients undergoing auditory brainstem response testing. and fentanyl-ketamine. Anesthesiology. 2000. [PubMed] 3. Hypnotic and anesthetic interactions between ketamine and midazolam in female patients. Gin T. [PubMed] 8. J Anesth. mivacurium or placebo to facilitate laryngeal mask airway insertion. s-ketamine on intubating conditions during induction of anaesthesia with etomidate and rocuronium. Hong W. Hui TW. [PubMed] 4. Br J Anaesth. Cheam EW. Akinci SB.1.46:24–7. ketamine. Int J Pediatr Otorhinolaryngol. [PubMed] 7.55:323–6. Pamuk AG. Ledowski T. Suen T. Koseoglu A. [PubMed] . 1995.79:1227–32.82:641–8. Mackie DP. 2009.69:162–7. Plummer JL. Eur J Anaesthesiol. Takada M. Chui PT. Wulf H. Paediatr Anaesth.19:500–6. Hypnotic and anaesthetic interactions between midazolam. Boyaci A. [PubMed] 5. Hemodynamic stability during induction of anaesthesia and tracheal intubation with Propofol plus fentanyl. Akin A.15:191–6. Aypar U.18:519–23. Niemeijer RP. Esmaoqlu A. Short TG.69:1541–5. Ohta S. Hui TW. Anaesthesia. Dohi S. Hong W. [PubMed] 9. Hayakawa-Fujii Y. Anesthesiology. Randomized double-blind comparison of fentanyl. 2001. Gulcu N. 2005. Erden IA. Aydogan H. Ketamine as analgesic for total intravenous anaesthesia with propofol. Chui PT.