Comparative study between Ketamine and Propofol versus Ketamine and Dexmedetomidine for Monitored Anaesthesia Care for Dilatation and Curettage surgeries in Daycare procedures

Ayaskant Sahoo, Nagasatyasuryanarayana Ruttala, Rajendra Prasad, Swikruti Behera, E. Banavathu
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Abstract

Introduction. Anaesthesia is frequently administered through Monitored Anaesthesia Care (MAC) utilising various combinations of anaesthetic drugs for moderately painful operations like Dilatation and Curettage (D&C), which is preferably done as a daycare procedure. The hunt for improved drug combinations is always ongoing, and the pharmacological properties of the individual drugs are considered. In this regard, anaesthesiologists all over the world are quite fond of the combination of Ketamine and Propofol, which is also known as Ketofol. Recently, especially in situations involving MRI sedation, the combination of ketamine and dexmedetomidine (Dexket) has gained popularity. This study compares the combinations for MAC during D&C surgeries in a daycare setting. Aim. The primary objective was to estimate the recovery times using either combination. Secondarily, we would also compare the duration of analgesia, the haemodynamics, and the side-effect profiles of the two combinations. Material and Methods. This study enrolled 60 patients posted for elective D&C. According to standard institutional protocols, they were administered Ketofol(KP group) or Dexket(KD group), depending on the anaesthesia provider’s choice. The Ketofol group received Ketamine 1mg/kg and Propofol 1mg/kg with boluses of Ketamine 0.25mg/kg to maintain the depth of anaesthesia using Ramsay sedation score(RSS) >3. KD group received Dexmedetomidine intravenously 1mic/kg over 10 minutes followed by ketamine 1mg/kg boluses of Ketamine 0.25mg/kg to maintain the adequate anaesthetic depth of RSS>3. Results. The Recovery time in post-operative period was significantly prolonged in the KD group (mean 22.77 minutes) compared to the KP group (mean 17.8 minutes). The total duration of analgesia was also longer in the KD group (250 minutes vs 220 minutes in the KP group). It was seen that the hemodynamic variables (HR, SBP, DBP) were consistently higher in the KD group compared to the KP group. There was a significant difference in SBP, DBP, and MAP in the intraoperative period between the KP and KD groups till 4hr in the postoperative period. Conclusions. We conclude that a combination of Dexmedetomidine and Ketamine has longer recovery times and analgesia duration than a combination of Propofol and Ketamine. Side effects like postoperative nausea and vomiting are not significant. However, since the recovery times are comparatively longer in a daycare setting, dexmedetomidine and Ketamine may not be the preferred agents compared to the combination of Ketamine and Propofol in the context of a daycare setting.
氯胺酮和异丙酚与氯胺酮和右美托咪定在日间护理程序中用于扩张和刮宫手术的监测麻醉护理的比较研究
导言。麻醉通常是通过监测麻醉护理(MAC)进行的,利用各种麻醉药物的组合来进行中度疼痛的手术,如扩张和刮宫术(D&C),这种手术最好在日间进行。人们一直在寻找更佳的药物组合,并考虑单种药物的药理特性。在这方面,全世界的麻醉师都非常喜欢氯胺酮和异丙酚的组合,也就是所谓的 Ketofol。最近,特别是在涉及磁共振成像镇静的情况下,氯胺酮和右美托咪定(Dexket)的组合也越来越受欢迎。本研究比较了在日间护理环境中进行剖腹产手术时使用氯胺酮和右美托咪定的组合。主要目的是估算两种组合的恢复时间。其次,我们还将比较两种组合的镇痛持续时间、血液动力学和副作用情况。本研究共收录了 60 名选择性剖宫产的患者。根据机构的标准方案,根据麻醉提供者的选择,给他们使用酮洛酚(KP 组)或右旋酮(KD 组)。KP 组使用氯胺酮 1 毫克/千克和丙泊酚 1 毫克/千克,并注射氯胺酮 0.25 毫克/千克,以维持拉姆塞镇静评分(RSS)大于 3 的麻醉深度;KD 组在 10 分钟内静脉注射右美托咪定 1 毫克/千克,然后注射氯胺酮 1 毫克/千克和氯胺酮 0.25 毫克/千克,以维持 RSS 大于 3 的适当麻醉深度。KD 组术后恢复时间(平均 22.77 分钟)明显长于 KP 组(平均 17.8 分钟)。KD 组的总镇痛时间也更长(250 分钟对 KP 组的 220 分钟)。与 KP 组相比,KD 组的血液动力学变量(HR、SBP、DBP)一直较高。KP 组和 KD 组在术中直到术后 4 小时的 SBP、DBP 和 MAP 均有明显差异。我们得出的结论是,右美托咪定和氯胺酮联合用药比丙泊酚和氯胺酮联合用药的恢复时间和镇痛持续时间更长。术后恶心和呕吐等副作用并不明显。不过,由于在日间护理环境中恢复时间相对较长,因此在日间护理环境中,右美托咪定和氯胺酮与氯胺酮和异丙酚的组合相比可能不是首选药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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