COMPARATIVE STUDY OF PROPOFOL-KETAMINE VS KETAMINE FOR TIVA IN DAY CARE SURGERIES

Dr. Mukund Nayak; Dr. Archana Mhatre

Volume : VIII, Issue : VII, July - 2019

COMPARATIVE STUDY OF PROPOFOL-KETAMINE VS KETAMINE FOR TIVA IN DAY CARE SURGERIES

Dr. Mukund Nayak, Dr. Archana Mhatre

Abstract :

There is an ongoing quest to know which agent is better for outpatient day care surgeries. The main aim of present study was to compare the effects of combination of Ketamine and Propofol as anaesthetic agent as against plain ketamine with respect to change in heart rate, blood pressure, oxygen saturation, total dose required, emergence phenomenon and total recovery time. Materials and Methods: In this hospital based comparative study, 60 patients of ASA I & II scheduled for day care surgeries were taken. Patients were divided into two equal groups. Group A: Induction was done with injection ketamine 1 mg/kg and Propofol 2.5 mg/kg intravenously and maintained on propofol infusion of 6 mg/kg/hr till end of surgery. Group B: Induction was done with injection Ketamine 2 mg/kg intravenously and maintained on ketamine infusion of 40 mcg/kg/min till end of surgery. In both the groups pulse rate, systolic, diastolic and mean blood pressure, oxygen saturation were measured along with emergence phenomenon and recovery. Data obtained was compared using statistical package of SPSS – 20. Result: The effect of Propofol – ketamine combination and ketamine were observed with respect to haemodynamic stability, changes in oxygen saturation and respiratory rate, total dose of drug required incidence of emergence phenomenon and other side effect. Post operatively along with recovery time, pulse rate and blood pressure increased in both the groups immediately following induction but were insignificant. Intra – op rise in pulse rate and blood pressure were significant with rise in Group B more than in Group A. There was not much change observed in respiratory rate and oxygen saturation and was statistically insignificant. In Group B, number of patients with side effects like emergence phenomenon and lacrimation were significantly higher in Group A. The average dose of ketamine required was around 51.63mg/ procedure in group A as against 137 mg/procedure in group B. On comp� the recovery between the two groups it was seen that on an average patients were able to respond to verbal commands at 20.93 minutes in Group A as against 31.30 minutes in Group B, they were able to sit without support at 35.83 minutes in group A and 66.20 minutes in group B, and they were able to walk in straight line with Rhomberg�s test steady at 52.23 minutes in group A and 105.7 minutes in group B. Application of appropriate statistical tests showed that these values were statistically significant. Conclusion: we can conclude that Propofol – Ketamine combination has several advantages over Ketamine alone when used in day care surgery like 1. Reduced drug requirement of Ketamine 2. Maintenance of hemodynamic stability intraoperatively 3. Maintenance of spontaneous natural airway eathing during anaesthesia 4. Lower incidence of intraoperative apnoea 5. Greater propensity to minimize the intensity of emergence reactions of Ketamine and 6. Shorter recovery times as compared to Ketamine alone