TOTAL INTRAVENOUS ANAESTHESIA: COMPARISON OF PROPOFOL- KETAMINE AND PROPOFOL- DEXMEDETOMIDINE COMBINATIONS

Kanhaiya Lal Kishnani, Sanjay P Dave

Abstract


Rising cost of medical treatment and the reimbursement of medical expenses by medical insurance provider companies’ emphasis on day care surgery are on rise. Previously day care surgeries were being performed under General Anaesthesia which is costlier than TIVA. GA require specific vaporizers for inhalational volatile anaesthetics requiring frequent calibrations and maintenance and produces pollution of working area.

TIVA has advantages of smooth induction and maintenance of anaesthesia, fewer incidences of side post operative nausea and vomiting, smooth recovery and minimal side effects,  has predictable action of drugs, the oxygen demand is minimal or nil. TIVA can be practised easily in less equipped hospitals and, convenient to use. The search for newer and more convenient as well as safer combinations of drugs in TIVA is being done to achieve the goals.   

         The main aim of study was to compare two combinations of drugs 1) Propofol and Ketamine and 2) Propofol and Dexmedetomidine in TIVA for short surgical procedures.                                                 

Material and Method

Total 100 patients of between the age group of 20 years to 65 years belonging to ASA Group I and II of either sex undergoing short surgical procedures were included in the study.

The patients were divided in two groups, one group of 50 patients each. Group 1) PK group received Propofol and Ketamine, while group 2) PD group received Propofol and dexmedetomidine combination. In group I (PK) the induction was done with Propofol 1.0 mg/kg body wt. and Ketamine 1.0 mg/kg body wt and in group II (PD group) induction was done with Propofol 1.0 mg/kg body wt. plus Dexmedetomidine 1.0 mcg /kg body wt. Vital parameters were continuously monitored. All the patients of both groups were monitored and followed up in post operative period for any symptoms.

Conclusion

Present study suggest that both the combinations of Propofol and Ketamine as well as Propofol and Dexmedetomedine are equally effective in TIVA, the less hemodynamic effects, minimal side effects and are safe. The recovery features are identical in post operative period. Both the combinations produce rapid, pleasant, smooth and swift recovery with minimal residual impairment of mental functions with stable hemodynamic status.


Keywords


TIVA, Propofol, Ketamine, Dexmedetomidine.

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References


Nielsen PF, Ahlburg P, Sosted EE, Christensen JH. The dosage-effect-curves for propofol in young and elderly patients and modifications of these following fentanyl. Ugeskr Laeger. 1992;154:1907–10. [Pub Med]

Hernandez C, Parramon F, Garcia-Velasco P, Vilaplana J, García C, Villalonga A. Comparative study of 3 techniques for total intravenous anesthesia: Midazolam-ketamine, propofol-ketamine, and propofol-fentanyl. Rev Esp Anestesiol Reanim. 1999;46:154–8. [Pub Med]

Canpolat DG1, Yildirim MD2, Kutuk N3, Dogruel F3, Ocak H2, Aksu R4, Alkan A5 Comparison of ketamine-propofol and ketamine-dexmedetomidine combinations in children for sedation during tooth extraction. J Pak Med Assoc. 2017 May;67(5):693-697.

Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J. Additive interactions between propofol and ketamine when used for anesthesia induction in female patients. Anesthesiology. 1995;82:641–8. [Pub Med]

Gill SS, Wright EM, Reilly CS. Pharmacokinetic interaction of propofol and fentanyl: Single bolus injection study. Br J Anaesth. 1990;65:760–5. [Pub Med]

Steward DJ. A simplified scoring system for the postoperative recovery room. Canad Anaesth Soc J.1975;22:111–2. [Pub Med]

Jakobsson J, Oddby E, Rane K. Patient evaluation of four different combinations of intravenous anaesthetics for short outpatient procedures. Anaesthesia. 1993;48:1005–7. [Pub Med]

Benito MC, Gonzalez-Zarco LM, Navia J. Total intravenous anesthesia in general surgery. Rev Esp Anestesiol Reanim. 1994;41:292–5. [Pub Med]

Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Can J Anaesth.1991;38:330–4. [Pub Med]


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