Öz
Aim: Research into ideal sedative agents for patient comfort, cardiopulmonary stability and fast recovery without mental impairments continues. Our primary objectives were to compare haemodynamic parameters, recovery time, emergence reactions,
vomiting and satisfaction ratios between groups administered propofol-ketamine or propofol.
Material and Method: Sixty-one ASA I-III adult patients undergoing elective orthopaedic lower limb surgery under spinal anaesthesia
were studied. The Mini-mental State examination was used preoperatively and post-operatively. Vital signs were recorded preoperatively, during surgery and during recovery. After sensory block was obtained, patients received a 0.4 mg kg-1 propofol loading dose. Pre-surgery, continuous infusions started: Group P, propofol with saline; Group KP, propofol with ketamine in a 3: 1 ratio. Postsurgery, in the post-anaesthesia care unit, patients’ vital signs were monitored, and side-effects and satisfaction ratios recorded.
Results: The groups did not differ in demographic variables. There was no statistically significant difference in preoperative and postoperative MMT examination scores, systolic blood pressure, mean blood pressure, heart rate, respiratory rate or oxygen saturation between groups (p>0.05). But in group P four patients had deep hypotension and two of them need sedation termination. Mean recovery time of Group KP and Group P was 14 min and 7 min, respectively. No respiratory adverse event was observed. In Group KP, four patients vomited. There were no psychomimetic adverse reactions.
Conclusion: It was found that ketamine infusion (ratio 3: 1) prolonged recovery time but it is far less important near its haemodynamic benefits. In this combination, propofol may counterbalance psychomimetic effects of ketamine, but not vomiting
Anahtar Kelimeler
Kaynakça
- 1. De Andres J, Valia JC, Bolinches R. Predictors of patient satisfaction with regional anesthesia. RegAnesth 1995;20(6):498–505.
- 2. Asehnoune K, Albaladejo P, Smail N, Heriche C, Sitban P, Gueneron JP, et al. Information and anaesthesia: what does the patient? Ann Fr Anesth Reanim 2000;19(8):577–81.
- 3. Kinirons BP, Bouaziz H, Paqueron X. Sedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block. AnesthAnalg 2000;90:1118–21.
- 4. Höhener D, Blumenthal S, Borgeat. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100(1):8–16.
- 5. Folstein MF, Folstein SE, McHugh PR. ‘’Mini-Mental State’’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–98.
- 6. Ramsey MAE, Savege TM, Simpson BR, Goodwin R. With controlled sedation alphaxalone-alphadolone. Br Med J 1974;22(2):656–9.
- 7. Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresan C, Goodale DB, et al. The influence of age on propofol pharmacodynamics. Anaesthesiology 1999;90(6):1502–16.
- 8. Wilson E, David A, MacKenzie N, Grant IS. Sedation during spinal anesthesia: comparison of propofol and midazolam. Br J Anaesth 1990;64(1):48–52.
- 9. Borgeat A, Wilder-Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol possess direct antiemetic properties. AnesthAnalg 1992;74(4):539–41.
- 10. Mingus ML, Monk TG, Gold MI, Jenkins W, Roland C. Remifentanil versus propofol as adjuncts to regional anesthesia. J ClinAnesth 1998;10(1):46–53.
- 11. Lauwers MH, Vanlersberghe C, Camu F. Comparison of remifentanil and propofol infusions for sedation during regional ansthesia. RegAnesth Pain Med 1998;23:64–70.
- 12. Blouin RT, Seifert HA, Babenco HD, Conard PF, Gross JB. Propofol depresses the hypoxic ventilatory respons during conscious sedation and isohypercapnia. Anaesthesiology 1993;79(6):1177–82.
- 13. Nieuwenhuijs D, Sarton E, Teppema L, Dahan A. Propofol for monitored anaesthesia care: implications on hypoxic contol of cardiorespiratory responses. Anaesthesiology 2000;92(1):46–54.
- 14. Servin FS, Raeder JC, Merle Jc, Reite K, Marty J, Lauwers MH, et al. Remifentanil sedation compared with propofol during regional anesthesia. ActaAnaesthesiolScand 2002;46(3):309–15.
- 15. Holas A, Krafft P, Marcovic M, Et al. Remifentanil, propofol or both for concious sedation during eye surgery under regional anesthesia. Eur J Anaesth 1999;16:741–48.
- 16. Frizelle HP, Duranteau J, Samii K. A comparison of propofol with a propofol-ketamine combination for sedation during spinal anesthesia. AnesthAnalg 1997;84(6):1318–22.
- 17. Miller AC, Jamin CT, Elamin EM. Continuous intravenous infusion of ketamine for maintenance sedation. Minerva Anestesiol 2011;77(8):812–20.
- 18. Petrillo TM, Fortenberry JD, Linzer Jf, Simon HK. Emergency department use of ketamine in pediatric status asthmaticus. J Asthma 2001;38(8):357–64.
- 19. Lau TT, Zed PJ. Does ketamine have a role in managing severe exacerbation of asthma in adults? Pharmacotherapy 2001;21:1100–6.
- 20. Tokics L, Strandberg A, Brismar B, Lundquist H, HedenstiernaG. Computarized tomography of the chest and gas exchange measurements during ketamine anaesthesia. ActaAnaesthScand 1987;31(89):384–92.
- 21. Youssef-Ahmed MZ, Silver P, Nimkoff L. Continuous infusion of ketamine in mechanically ventilated children wtih refractory bronchospasm. Intensive Care Med 1996;22:972–6.
- 22. Hedenstierna G. Pulmonary perfusion during anesthesia and mechanical ventilation. Minerva Anesthesiol 2005;71(1):319–24.
- 23. Park Gr, Manara AR, Mendel L, Bateman PE. Ketamine infusion. Its use as a sedative, inotrope and bronchodilator in a critically ill patient. Anaesthesia 1987;42(9):980–3.
- 24. Williams GD, Philip BM, Chu LF, Boltz MG, Kamra K, Terwey H, et al. Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. AnesthAnalg 2007;105(6):1578–84
- 25. Hijazi Y, Bodonian C, Bolon M, Salord F, Baulieu R. Pharmacokinetics and haemodynamics of ketamine in intensive care patients with brain or spinal cord injury. Br J Anaesth 2003;90(2):155–60.
- 26. Kolenda H, Gremmelt A, Rading S, Braun U, Markakis E. Ketamine for analgosedative therapy in intensive care treatment of head-injured patients. ActaNeurochir (Wien)1996;138(10):1193–9.
- 27. Tobias JD, Martin LD, Wetzel RC. Ketamine by continuous infusion for sedation in the pediatric intensive care unit. Crit Care Med 1990;18(8):819–21.
- 28. Andolfatto G, Willman E. A prospective case series of singlesyringe ketamine-propofol (ketofol) for emergency department procedural sedation and analgesia in adults. Academic Emergency Medicine 2011;18(3):237–45.
- 29. Akin A, Esmaoglu A, Guler G. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatric Cardiology 2005;26:553–7.
- 30. Badrinath S, Syhmala B, Avramov M, Witt TR, Ivankovich AD. The use of ketamine-propofol combination during monitored anesthesia care. AnesthAnalg 2000;90(4):858–62.
- 31. Messenger DW, Murray HE, Dungey PE, Van Vlyman J, Sivilotti ML. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol sedation: a randomized clinical trial. Academic Emergency Medicine 2008;15(10):877–86.
- 32. Craven R. Ketamine. Anaesthesia 2007;62:48–53.
- 33. Erden IA, Pamuk AG, Akinci SB, Koseoglu A, Aypar U. Comparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures. Minerva Anesthesiol 2010;76:260–5.
- 34. Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med 2008;26(9):985–1028.
- 35. Guit JBM, Koning HM, Coster ML, Niemeijer RP, Machie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1990;46(1):24–7.
- 36. Idvall J, Ahlgren I, Aronson KF, Stenberg P. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth 1979;51(12):1167–72.
- 37. Frey K, Sukhani R, Pawlowsky J, Pappas AL, Nikat-Stevens M. Propofol versus propofol-ketamine sedation for retrobulbar nerve block: comparison of sedation quality, intraocular pressure changes, and recovery profiles. AnesthAnalg 1999;89(2):317–21.
Spinal Anestezi Sırasında Verilen Sedasyonda Kullanılan Propofol ve Ketofol Yan Etkilerinin Karşılaştırılması
Öz
Amaç: Hasta konforu, kardiyopulmoner stabilite ve zihinsel bozukluklar olmaksızın hızlı derlenme için en ideal sedatif ajan seçimi
üzerine araştırmalar devam etmektedir. Bu çalışmadaki hedefimiz, sedasyonda propofol-ketamin veya propofol uygulanan
gruplarda hemodinamik parametreleri, derlenme süresi, derlenme komplikasyonları, kusma ve hasta memnuniyet oranları açısından karşılaştırmaktı.
Materyal ve Metot: Spinal anestezi altında elektif ortopedik alt ekstremite cerrahisi planlanan ASA I-III 61 erişkin hasta çalışmaya
alındı. Tüm hastalara preoperatif ve postoperatif Mini-Mental Test uygulandı. Ameliyat öncesi, ameliyat sırasında ve derlenme sırasında vital bulgular kaydedildi. Spinal blok elde edildikten sonra, hastalara 0,4 mg kg-1 propofol yükleme dozu verildi ve takibinde ilaç infüzyonları başlatıldı (Grup P, salin+ propofol; Grup KP, 3: 1 oranında ketamin+propofol). Ameliyat sonrası derlenme ünitesinde hastaların vital bulguları, yan etkiler ve memnuniyet oranları kaydedildi.
Bulgular: Gruplar demografik değişkenlerde farklılık göstermedi. Preoperatif ve postoperatif MMT muayene skorlarında, sistolik kan
basıncında, ortalama kan basıncında, kalp atım hızında, solunum sayısı veya oksijen satürasyonunda gruplar arasında istatistiksel
olarak anlamlı fark yoktu (p>0,05). Ancak Grup P’de dört hastada derin hipotansiyona gözlendi ve ikisinde sedasyon durduruldu.
Grup KP ve Grup P’nin ortalama derlenme zamanı sırasıyla 14 ve 7 dakika idi. Hiçbir solunum sistemi yan etkisi gözlenmedi. Grup
KP’de dört hasta da kusma gözlendi. Hiçbir psikomimetik advers reaksiyon gelişmedi.
Sonuç: Ketamin infüzyonunun (3: 1 oranı) ciddi hemodinamik fayda sağlamasının yanında derlenme süresini uzattığı gözlemlendi.
Ayrıca bu doz kombinasyonuyla propofolün ketaminin psikomimetik etkilerini baskılayabildiğini ama kusmayı engelleyemediğini
sonucuna varıldı.
Anahtar Kelimeler
Kaynakça
- 1. De Andres J, Valia JC, Bolinches R. Predictors of patient satisfaction with regional anesthesia. RegAnesth 1995;20(6):498–505.
- 2. Asehnoune K, Albaladejo P, Smail N, Heriche C, Sitban P, Gueneron JP, et al. Information and anaesthesia: what does the patient? Ann Fr Anesth Reanim 2000;19(8):577–81.
- 3. Kinirons BP, Bouaziz H, Paqueron X. Sedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block. AnesthAnalg 2000;90:1118–21.
- 4. Höhener D, Blumenthal S, Borgeat. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100(1):8–16.
- 5. Folstein MF, Folstein SE, McHugh PR. ‘’Mini-Mental State’’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–98.
- 6. Ramsey MAE, Savege TM, Simpson BR, Goodwin R. With controlled sedation alphaxalone-alphadolone. Br Med J 1974;22(2):656–9.
- 7. Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresan C, Goodale DB, et al. The influence of age on propofol pharmacodynamics. Anaesthesiology 1999;90(6):1502–16.
- 8. Wilson E, David A, MacKenzie N, Grant IS. Sedation during spinal anesthesia: comparison of propofol and midazolam. Br J Anaesth 1990;64(1):48–52.
- 9. Borgeat A, Wilder-Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol possess direct antiemetic properties. AnesthAnalg 1992;74(4):539–41.
- 10. Mingus ML, Monk TG, Gold MI, Jenkins W, Roland C. Remifentanil versus propofol as adjuncts to regional anesthesia. J ClinAnesth 1998;10(1):46–53.
- 11. Lauwers MH, Vanlersberghe C, Camu F. Comparison of remifentanil and propofol infusions for sedation during regional ansthesia. RegAnesth Pain Med 1998;23:64–70.
- 12. Blouin RT, Seifert HA, Babenco HD, Conard PF, Gross JB. Propofol depresses the hypoxic ventilatory respons during conscious sedation and isohypercapnia. Anaesthesiology 1993;79(6):1177–82.
- 13. Nieuwenhuijs D, Sarton E, Teppema L, Dahan A. Propofol for monitored anaesthesia care: implications on hypoxic contol of cardiorespiratory responses. Anaesthesiology 2000;92(1):46–54.
- 14. Servin FS, Raeder JC, Merle Jc, Reite K, Marty J, Lauwers MH, et al. Remifentanil sedation compared with propofol during regional anesthesia. ActaAnaesthesiolScand 2002;46(3):309–15.
- 15. Holas A, Krafft P, Marcovic M, Et al. Remifentanil, propofol or both for concious sedation during eye surgery under regional anesthesia. Eur J Anaesth 1999;16:741–48.
- 16. Frizelle HP, Duranteau J, Samii K. A comparison of propofol with a propofol-ketamine combination for sedation during spinal anesthesia. AnesthAnalg 1997;84(6):1318–22.
- 17. Miller AC, Jamin CT, Elamin EM. Continuous intravenous infusion of ketamine for maintenance sedation. Minerva Anestesiol 2011;77(8):812–20.
- 18. Petrillo TM, Fortenberry JD, Linzer Jf, Simon HK. Emergency department use of ketamine in pediatric status asthmaticus. J Asthma 2001;38(8):357–64.
- 19. Lau TT, Zed PJ. Does ketamine have a role in managing severe exacerbation of asthma in adults? Pharmacotherapy 2001;21:1100–6.
- 20. Tokics L, Strandberg A, Brismar B, Lundquist H, HedenstiernaG. Computarized tomography of the chest and gas exchange measurements during ketamine anaesthesia. ActaAnaesthScand 1987;31(89):384–92.
- 21. Youssef-Ahmed MZ, Silver P, Nimkoff L. Continuous infusion of ketamine in mechanically ventilated children wtih refractory bronchospasm. Intensive Care Med 1996;22:972–6.
- 22. Hedenstierna G. Pulmonary perfusion during anesthesia and mechanical ventilation. Minerva Anesthesiol 2005;71(1):319–24.
- 23. Park Gr, Manara AR, Mendel L, Bateman PE. Ketamine infusion. Its use as a sedative, inotrope and bronchodilator in a critically ill patient. Anaesthesia 1987;42(9):980–3.
- 24. Williams GD, Philip BM, Chu LF, Boltz MG, Kamra K, Terwey H, et al. Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. AnesthAnalg 2007;105(6):1578–84
- 25. Hijazi Y, Bodonian C, Bolon M, Salord F, Baulieu R. Pharmacokinetics and haemodynamics of ketamine in intensive care patients with brain or spinal cord injury. Br J Anaesth 2003;90(2):155–60.
- 26. Kolenda H, Gremmelt A, Rading S, Braun U, Markakis E. Ketamine for analgosedative therapy in intensive care treatment of head-injured patients. ActaNeurochir (Wien)1996;138(10):1193–9.
- 27. Tobias JD, Martin LD, Wetzel RC. Ketamine by continuous infusion for sedation in the pediatric intensive care unit. Crit Care Med 1990;18(8):819–21.
- 28. Andolfatto G, Willman E. A prospective case series of singlesyringe ketamine-propofol (ketofol) for emergency department procedural sedation and analgesia in adults. Academic Emergency Medicine 2011;18(3):237–45.
- 29. Akin A, Esmaoglu A, Guler G. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatric Cardiology 2005;26:553–7.
- 30. Badrinath S, Syhmala B, Avramov M, Witt TR, Ivankovich AD. The use of ketamine-propofol combination during monitored anesthesia care. AnesthAnalg 2000;90(4):858–62.
- 31. Messenger DW, Murray HE, Dungey PE, Van Vlyman J, Sivilotti ML. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol sedation: a randomized clinical trial. Academic Emergency Medicine 2008;15(10):877–86.
- 32. Craven R. Ketamine. Anaesthesia 2007;62:48–53.
- 33. Erden IA, Pamuk AG, Akinci SB, Koseoglu A, Aypar U. Comparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures. Minerva Anesthesiol 2010;76:260–5.
- 34. Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med 2008;26(9):985–1028.
- 35. Guit JBM, Koning HM, Coster ML, Niemeijer RP, Machie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1990;46(1):24–7.
- 36. Idvall J, Ahlgren I, Aronson KF, Stenberg P. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth 1979;51(12):1167–72.
- 37. Frey K, Sukhani R, Pawlowsky J, Pappas AL, Nikat-Stevens M. Propofol versus propofol-ketamine sedation for retrobulbar nerve block: comparison of sedation quality, intraocular pressure changes, and recovery profiles. AnesthAnalg 1999;89(2):317–21.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2017 |
| Yayımlandığı Sayı | Yıl 2017 Yıl: 2017 Sayı: 3 |