The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

Yıl 2017, Yıl: 2017 Sayı: 3, 236 - 242, 01.12.2017

Aysu Hayriye Tezcan , Dilşen Hatice Önek Nurcan Yavuz Hidayet Ünal Aysun Nadide Postacı Hülya Özden Terzi Mustafa Baydar Onur Özlü

https://doi.org/10.5505/kjms.2017.72324

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

Spinal anaesthesia, sedation, propofol, ketamine

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

Spinal anestezi, sedasyon, propofol, ketamin

Kaynakça

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