Online ISSN: 2515-8260

Keywords : Ketofol


A COMPARISON OF PROPOFOL VERSUS KETOFOL PLUS FENTANYL AS INDUCTION AGENTS ON HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANESTHESIA

Krishna Reddy Pingili, Raghuveer Chinnapaka, Nandaraj Dubbaka, M. Sindhura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2407-2417

Background: Propofol has gained a lot of popularity and is very commonly used in elective surgeries due to its solubility, rapid induction, quick recovery time along with its amnestic and antiepileptic properties make a potent anesthetic agent. Exclusive uses of propofol to provide LMA might be associated with some undesirable effects which are dose-dependent are like hypotension, respiratory depression, coughing, hiccups, laryngospasm, and movements. Forgoing studies reveled that a combination of ketamine and propofol decreased patients' use of propofol and opioids and improved hemodynamic and respiratory stability. The prime objective of our study is to substantiate the earlier results regarding whether the efficacy of the ketamine-Propofol-Fentanyl combination has more favorable hemodynamics than the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients and to compare the additional post-operative analgesia requirements between the two groups.
Materials and Methods: The clinical prospective observational study was done on 240 individuals which were divided in to 2 equal groups (120 each group), the, Group A (Propofol) received 2.5 mg/kg Propofol for induction and the Group B (Ketamine-Fentanyl-Propofol) of 120 subjects, provided with 0.8mg/kg of ketamine + 0.2mg/kg fentanyl + 1mg/kg of Propofol. Patients in both - groups were maintained with O2, N2O, Sevoflurane and measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Additional analgesia (0.2 mg/kg ketamine, 0.1mg/kg fentanyl and 0.3 mg/kg propofol, for a total of 1mg/kg ketamine, 0.3 mg/kg fentanyl and 1.3 mg/kg propofol) was supplied to all patients with a VAS > 3 who reported pain. Independent samples t-test and paired t-test were employed for analysis of the collected data.
Results: In Group B (KP), the systolic, diastolic, mean arterial blood pressure, and heart rate changes following LMA implantation were considerably greater than in Group A (P). Group B had longer recovery durations, lower VAS scores immediately following surgery, and less analgesic needs. There was no incidence of apnea, hypoventilation, or emerging responses.
Conclusion: Ketofol (0.8mg/kg ketamine and 1 mg/kg propofol) + 0.2mg/kg fentanyl has multiple advantages than relaying propofol (2.5mg/kg) alone Hemodynamic stability, absence of respiratory depression, rapid recovery, and potent postoperative analgesia. We thus advocate intravenous ketofol as an induction drug, particularly for patients undergoing short surgical operations.

A Comparison of Ketamine-Propofol Versus Propofol as Induction Agents on Hemodynamic Parameters in Patients Undergoing Elective Surgical Procedures Under General Anesthesia

Prathap Sidda, Jhansi Gurram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5016-5028

Background:Propofol produces quick induction and recovery, depresses airway
reflexes, and is used for sedation and anaesthesia; nevertheless, it is associated with
dose-dependent hypotension and respiratory depression.It can produce coughing,
hiccups, laryngospasm, and movements when used as a sole agent to provide LMA.In
addition to its amnesic and analgesic effects, ketamine raises heart rate and blood
pressure through stimulating the sympathetic nervous system.It was shown that a
combination of ketamine and propofol decreased patients' use of propofol and opioids
and improved their hemodynamic and respiratory stability. Objectives:1. Determine
whether the ketamine-Propofol combination has more favourable hemodynamics than
the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients.2.
To compare the additional post-operative analgesia requirements between the two
groups.
Materials and Methods: Group KP, the Ketamine-Propofol Group, provided 0.75mg/kg
of ketamine and 1.5mg/kg of Propofol to 60 patients with ASA status I who were
randomly divided into two groups. Group P – Propofol Group received 2 mg/kg
Propofol for induction. The airway is secured with LMA, and patients in both groups
were maintained with O2, N2O, and Sevoflurane. For the next 15 minutes, every three
minutes, the baseline hemodynamics, heart rate, NIBP, Spo2, and respiratory rate were
recorded. Pain scores were measured for each subject post-operatively. Additional
analgesia was supplied to all patients with a VAS > 3 who reported pain.
Results: In Group KP, the systolic, diastolic, mean arterial blood pressure, and heart
rate changes following LMA implantation were considerably greater than in Group P.
Group KP had longer recovery durations, lower VAS scores immediately following
surgery, and less analgesic needs. In neither group was there an occurrence of apnea,
hypoventilation, or emerging responses.
Conclusion: Ketofol is a mixture of ketamine and Propofol that has multiple
advantages.Hemodynamic stability, absence of respiratory depression, rapid recovery,
and potent postoperative analgesia. We thus advocate intravenous ketofol as an
induction drug, particularly for patients undergoing short surgical operations.