The Comparison of Infusion of Two Different Sedation Regimens with Propofol and Ketamine Combination During Plastic and Reconstructive Surgery

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• 作者：Mehdi Sanatkar ; Shahriyar Haddadi Abianeh ; Shahrokh Ghazizadeh…
• 关键词：Propofol ; Ketamine ; Sedation ; Hemodynamic
• 刊名：Aesthetic Plastic Surgery
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：39
• 期：1
• 页码：141-146
• 全文大小：542 KB
• 参考文献：1. Hug CC Jr, McLeskey CH, Nahrwold ML, Roizen MF, Stanley TH, Thisted RA, Walawander CA, White PF, Apfelbaum JL, Grasela TH et al (1993) Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Analg 77(4 Suppl):S21–S29
  2. Bowdle TA, Radant AD, Cowley DS, Kharasch ED, Strassman RJ (1998) Roy-Byrne PP. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology 88(1):82-8 CrossRef
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  4. Mortero RF, Clark LD, Tolan MM, Metz RJ, Tsueda K, Sheppard RA (2001) The effects of small-dose ketamine on propofol sedation: respiration, postoperative mood, perception, cognition, and pain. Anesth Analg 92(6):1465-469 CrossRef
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  7. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2(5920):656-59 CrossRef
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  10. Erden IA, Pamuk AG, Akinci SB, Koseoglu A, Aypar U (2009) Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures. Paediatr Anaesth 19(5):500-06 CrossRef
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  16. Aouad MT, Moussa AR, Dagher CM, Muwakkit SA, Jabbour-Khoury SI, Zbeidy RA, Abboud MR, Kanazi GE (2008) Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand 52(4):561-65 CrossRef
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Plastic Surgery
  Otorhinolaryngology
  
• 出版者：Springer New York
• ISSN：1432-5241

文摘

Objective Anesthetic agents are often combined to enhance their therapeutic effects while minimizing adverse events. The aim of this study was to evaluate the effects of two different sedation regimens of ketamine and propofol combination via infusion on perioperative variables in patients who underwent plastic and reconstructive surgery. Methods This randomized double-blind clinical trial was done on 80 patients who were randomized to two groups; group 1 (n?=?40) received a 2:1 mixture of 9?mg/ml propofol and 4.5?mg/ml ketamine, and group 2 (n?=?40) received a 4:1 mixture of 9?mg/ml propofol and 2.25?mg/ml ketamine. After premedication and before local anesthetic injection, the infusion of mixtures was adjusted to attain the Ramsay sedation scores of 5 in both groups. We recorded induction time, sedation efficacy, cardiovascular and respiratory events, recovery time, and incidence of adverse events during and after the procedure. Results The mean of volume infusion of mixtures in the beginning of the procedure was higher in group 2 (3.2?±?1. 2?ml) than in group 1 (2.4?±?0.8?ml) (p?p?=?0. 92). The number of oversedated patients was greater in group 2 compared to group 1 but not statistically significant (p?=?0. 80). The sedation efficacy was similar between the two groups. The hemodynamic changes during the procedure were greater in group 2 compared to group 1 (p?=?0. 001). The recovery time was not significantly different between the two groups (p?=?0.43). The mean pain score in the recovery room was lower in group 1 than group 2 (1.2?±?0.8 vs 2.8?±?1.8, p?=?0. 01). Moreover, 4 (10?%) patients in group 1 and 10 (25?%) patients in group 2 needed opioid administration (p?=?0. 02). Other postoperative adverse events were similar between the two groups. Conclusion We recommend the use of a 2:1 combination of propofol–ketamine, because it reduced the rescue propofol requirement and consequently produced lower cardiovascular and respiratory depression effects and also less postoperative pain. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.