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Year 2002, Volume: 3 Issue: 1, 19 - 23, 01.04.2002

Abstract

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References

  • Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J.
  • uyanmayý karþýlaþtýrdýklarý çalýþmalarýnda propofol
  • ile olan uyanmanýn ketamin ve midazolamdan erken
  • olduðunu bildirmiþlerdir. Ketaminin bu özelliði
  • premedikasyon amacýyla rektal yolla kullanýlmasý
  • halinde de görülmekte ve ketaminin dozu arttýkça
  • genel anesteziden uyanma süresinin uzadýðý
  • belirtilmektedir. Ayrýca anesteziden uyanma süresi
  • ketaminin total kullanýlan dozu ile orantýlý olup,
  • ketamin dozu arttýkca hareket kabiliyetinin
  • kazanýlmasý, taburcu olmaya hazýrlýk ve gerçek taburcu olma süresi uzamaktadýr.
  • Yan etkilerinin çokluðu ketaminin kullanýmýný kýsýtlamaktadýr. Baþlýca yan etkileri santral sinir sisteminin uyarýlmasýna baðlýdýr. Olgularda postoperatif ayýlma sürecinde hipertansiyon, delirium, kabus ve halüsinasyon gibi komplikasyonlar görülebilir. Propofol ile ketamin birlikte kullanýldýðýnda, propofolün ketaminin yan etkilerini kaldýrmada etkili olduðu, stabil arteryal kan basýncý ve kalp atým hýzý saðlanýldýðý bildirilmektedir.9 Çalýþmamýzda oluþan komplikasyon farký istatistiksel olarak anlamlý deðildi. Bu kullandýðýmýz ketaminin subanestezik dozda olmasý ile iliþkili olabilir.
  • Çalýþmamýzda, postoperatif dönemde her iki grupta da istatistiksel olarak anlamlý kardiyovasküler sistem deðiþiklikleri saptanmadý. Bu durumun ketaminin etki süresinin (10-15dk) olgularýmýzdaki anestezi süresinden (150-158 dk) çok daha kýsa olmasýna baðlý olabileceði düþünülmüþtür.4,16 Postoperatif dönemde K/P grubunda istatistiksel olarak anlamlý olmasa da daha fazla hastada bulantý- kusma gözlendi. Bu duruým ketaminin postoperatif bulantý-kusmayý (PONV) artýrýcý etkisinden kaynaklanabilir.2,16
  • Sonuç olarak, indüksiyon öncesi propofole ketamin ilave edildiðinde postoperatif uyanmanýn gecikebileceði göz önünde bulundurulmalýdýr. Olgular, postoperatif dönemde Aldrete taburcu olma skoru ile yakýndan gözlenmeli ve özellikle uyanýklýk, solunum ve aktiviteleri tam olarak geri dönmeden servislerine taburcu edilmemelidir. 9 17 14 2,18
  • Additive interactions between propofol and ketamine
  • when used for anesthesia induction in female patients.
  • Anesthesiology 1995; 82: 641-8. 2. Badrinath S, Avramov MN, Shadrick M, Witt TR,
  • Ivankovich AD. The use of a ketamine-propofol
  • combination during monitored anesthesia care. Anesth
  • Analg 2000; 90: 858-62. 3. Friedberg BL. Propofol-ketamine technique. Aesthetic
  • Plast Surg 1993; 17: 297-300. 4. Esener Z. Klinik Anestezi. Ýkinci Baský. Ýstanbul:
  • LogosYayýncýlýk; 1997: 98-101. 5. Morgan GE, Mikhail MS, editors. Nonvolatil
  • anesthetic agents. Clinical Anesthesiology. 2 ed. New
  • Jersey:Apple and Lange; 1996:141-3. 6. Stephan H, Sonntag H, Schenk HD, Kettler D,
  • Khambatta HJ. Effects of propofol on cardiovascular
  • dynamics, myocardial blood flow and myocardial
  • metabolism in patients with coronary artery disease. Br
  • JAnaesth 1986; 58: 969-75. 7. Mayer M, Ochmann O, Doenicke A, Angster R,
  • Sutmann H. The effect of propofol-ketamine anesthesia
  • on hemodynamics and analgesia in comparison with
  • propofol-fentanyl.Anaesthesist 1990; 39: 609-12. 8. Tan CH., Onsiong MK., Kua SW. The effect of
  • ketamine pretreatment on propofol injection pain in
  • women.Anaesthesia 1998; 53: 302-5. 9. Guit JBM, Koning HM, Coster ML, Niemeijer RPE,
  • Mackie DP. Ketamine as analgesic for total intravenous
  • anaesthesia with propofol.Anaesthesia 1991; 46: 24-7. 10. Crozier TA, Sumpf E. The effect of total intravenous
  • anesthesia with S-(+)-ketamine/propofol on
  • hemodynamic, endocrine and metabolic stress
  • reactions in comparison to alfentanil/propofol in
  • laporotomy.Anaesthesist 1996; 45: 1015-23. 11. Botero CA, Smith CE, Holbrook C, Chavez AM, Snow
  • NJ, Hagen JF, Pinchak AC. Total intravenous
  • anesthesia with a propofol-ketamine combination
  • during coronary artery surgery. Cardiothorac Vasc
  • Anesth 2000; 14: 409-15. 12. Gray C, Swinhoe CF, Myint Y, Mason D. Target
  • controlled infusion of ketamine as analgesia for TIVA
  • with propofol. Can JAnaesth 1999; 46: 957-61 13. Alderson PJ, Lerman J. Oral premedication for
  • paediatric ambulatory anaesthesia: a comparison of
  • midazolam and ketamine. Can JAnaesth 1994; 41: 221- 6. 14. Tanaka M, Sato M, Saito A, Nishikawa T. Revaluation
  • of rectal ketamine premedication in children:
  • comparison with rectal midazolam. Anesthesiology
  • ; 93: 1217-24. 15. Viitanen H, Baer G, Annila P. Recovery
  • characteristhics of sevoflurane or halatone for day-case
  • anaesthesia in children aged 1-3 years. Acta
  • Anaesthesiol Scand 2000; 44: 101-6. 16. Collins VJ. Intravenous anesthesia: Nonbarbiturates
  • nonnarcotics. In: Principal of anesthesiology general
  • and regional anesthesiology. Third edition,
  • Philadelphia: Lea&Febiger, 1993: 734-87. 17. Ostreikov IF, Vasil'ev IaI, Milenin VV, Pivovarov SS,
  • Babaev BD. Clinical picture of awekening after general
  • anesthesia with midazolam, propofol, ketamine and
  • fluothane in children treated at one-day ambulatory
  • facility. Anesteziol Reanimatol 2001; 1: 36-8 (Abstract). 18. Kabutan K, Doi Y, Takehisa S, Morimoto N, Taniguchi
  • M. Evaluation of the ketamine maintenance dose in
  • anesthesia using propofol, ketamine and nitrous oxide.
  • Masui 1999; 48: 534-6 (Abstract). nd
  • Yrd. Doç. Dr. Osman Nuri AYDIN
  • ADÜ Týp Fakültesi Anesteziyoloji ve Reanimasyon
  • A.D., 09100 AYDIN Tlf Faks GSM E-posta
  • : onaydin@superonline.com
  • Geliþ Tarihi : 02.03.2002
  • Kabul Tarihi : 16.04.2002

The effect of Induction by Subanesthetic dose of Ketamine on Recovery From Anesthesia

Year 2002, Volume: 3 Issue: 1, 19 - 23, 01.04.2002

Abstract

Purpose: To evaluate the effect of a subanesthetic dose of ketamine added to propofol for anesthesia induction, on recovery from anesthesia, discharge time from the postoperative anesthesia care unit (PACU), and postoperative complications. Patients and method: The Ethical Committee of Adnan Menderes University, Medical Faculty, approved the study. Sixty-six patients with ASA Physical statuses I-II and between 20-65 years of age were prospectively investigated in a double blinded, randomised, prospective study. The patients were divided into two groups. In the first group anesthesia was induced with 2,5 mg/kg propofol (Group P), in the second group (Group K/P) 1 minute after 0,5 mg/kg ketamine 2,5 mg/kg propofol was administered. The duration of anesthesia, extubation time, admittance and discharge times at PACU, Aldrete scores and postoperative complications were recorded. Results: The extubation time and the period between extubation and admission to theEPACU were the same between the two groups. The time to discharge from the PACUEwas longer in group K/P than in group P (p= 0,006).Alderete scors were statistically lower in the group K/P than in the group Pat 10 and 1541 minute (p=0,039, 0,044 respectively). Aldrete scores increased significantly in both groups after patients were admitted to the PACU (p=0.000). In both groups, postoperative complication rate (p=0,095) and cardiovascular system changes were similar. Conclusion: We should be aware that postoperative emergence time could be late when ketamine is added to propofol in anesthesia induction. In the postoperative period, patients should be carefully observed and if emergence time is delayed or reversal of respiration and motor activation is not enough, discharge from PACU should be postponed.

References

  • Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J.
  • uyanmayý karþýlaþtýrdýklarý çalýþmalarýnda propofol
  • ile olan uyanmanýn ketamin ve midazolamdan erken
  • olduðunu bildirmiþlerdir. Ketaminin bu özelliði
  • premedikasyon amacýyla rektal yolla kullanýlmasý
  • halinde de görülmekte ve ketaminin dozu arttýkça
  • genel anesteziden uyanma süresinin uzadýðý
  • belirtilmektedir. Ayrýca anesteziden uyanma süresi
  • ketaminin total kullanýlan dozu ile orantýlý olup,
  • ketamin dozu arttýkca hareket kabiliyetinin
  • kazanýlmasý, taburcu olmaya hazýrlýk ve gerçek taburcu olma süresi uzamaktadýr.
  • Yan etkilerinin çokluðu ketaminin kullanýmýný kýsýtlamaktadýr. Baþlýca yan etkileri santral sinir sisteminin uyarýlmasýna baðlýdýr. Olgularda postoperatif ayýlma sürecinde hipertansiyon, delirium, kabus ve halüsinasyon gibi komplikasyonlar görülebilir. Propofol ile ketamin birlikte kullanýldýðýnda, propofolün ketaminin yan etkilerini kaldýrmada etkili olduðu, stabil arteryal kan basýncý ve kalp atým hýzý saðlanýldýðý bildirilmektedir.9 Çalýþmamýzda oluþan komplikasyon farký istatistiksel olarak anlamlý deðildi. Bu kullandýðýmýz ketaminin subanestezik dozda olmasý ile iliþkili olabilir.
  • Çalýþmamýzda, postoperatif dönemde her iki grupta da istatistiksel olarak anlamlý kardiyovasküler sistem deðiþiklikleri saptanmadý. Bu durumun ketaminin etki süresinin (10-15dk) olgularýmýzdaki anestezi süresinden (150-158 dk) çok daha kýsa olmasýna baðlý olabileceði düþünülmüþtür.4,16 Postoperatif dönemde K/P grubunda istatistiksel olarak anlamlý olmasa da daha fazla hastada bulantý- kusma gözlendi. Bu duruým ketaminin postoperatif bulantý-kusmayý (PONV) artýrýcý etkisinden kaynaklanabilir.2,16
  • Sonuç olarak, indüksiyon öncesi propofole ketamin ilave edildiðinde postoperatif uyanmanýn gecikebileceði göz önünde bulundurulmalýdýr. Olgular, postoperatif dönemde Aldrete taburcu olma skoru ile yakýndan gözlenmeli ve özellikle uyanýklýk, solunum ve aktiviteleri tam olarak geri dönmeden servislerine taburcu edilmemelidir. 9 17 14 2,18
  • Additive interactions between propofol and ketamine
  • when used for anesthesia induction in female patients.
  • Anesthesiology 1995; 82: 641-8. 2. Badrinath S, Avramov MN, Shadrick M, Witt TR,
  • Ivankovich AD. The use of a ketamine-propofol
  • combination during monitored anesthesia care. Anesth
  • Analg 2000; 90: 858-62. 3. Friedberg BL. Propofol-ketamine technique. Aesthetic
  • Plast Surg 1993; 17: 297-300. 4. Esener Z. Klinik Anestezi. Ýkinci Baský. Ýstanbul:
  • LogosYayýncýlýk; 1997: 98-101. 5. Morgan GE, Mikhail MS, editors. Nonvolatil
  • anesthetic agents. Clinical Anesthesiology. 2 ed. New
  • Jersey:Apple and Lange; 1996:141-3. 6. Stephan H, Sonntag H, Schenk HD, Kettler D,
  • Khambatta HJ. Effects of propofol on cardiovascular
  • dynamics, myocardial blood flow and myocardial
  • metabolism in patients with coronary artery disease. Br
  • JAnaesth 1986; 58: 969-75. 7. Mayer M, Ochmann O, Doenicke A, Angster R,
  • Sutmann H. The effect of propofol-ketamine anesthesia
  • on hemodynamics and analgesia in comparison with
  • propofol-fentanyl.Anaesthesist 1990; 39: 609-12. 8. Tan CH., Onsiong MK., Kua SW. The effect of
  • ketamine pretreatment on propofol injection pain in
  • women.Anaesthesia 1998; 53: 302-5. 9. Guit JBM, Koning HM, Coster ML, Niemeijer RPE,
  • Mackie DP. Ketamine as analgesic for total intravenous
  • anaesthesia with propofol.Anaesthesia 1991; 46: 24-7. 10. Crozier TA, Sumpf E. The effect of total intravenous
  • anesthesia with S-(+)-ketamine/propofol on
  • hemodynamic, endocrine and metabolic stress
  • reactions in comparison to alfentanil/propofol in
  • laporotomy.Anaesthesist 1996; 45: 1015-23. 11. Botero CA, Smith CE, Holbrook C, Chavez AM, Snow
  • NJ, Hagen JF, Pinchak AC. Total intravenous
  • anesthesia with a propofol-ketamine combination
  • during coronary artery surgery. Cardiothorac Vasc
  • Anesth 2000; 14: 409-15. 12. Gray C, Swinhoe CF, Myint Y, Mason D. Target
  • controlled infusion of ketamine as analgesia for TIVA
  • with propofol. Can JAnaesth 1999; 46: 957-61 13. Alderson PJ, Lerman J. Oral premedication for
  • paediatric ambulatory anaesthesia: a comparison of
  • midazolam and ketamine. Can JAnaesth 1994; 41: 221- 6. 14. Tanaka M, Sato M, Saito A, Nishikawa T. Revaluation
  • of rectal ketamine premedication in children:
  • comparison with rectal midazolam. Anesthesiology
  • ; 93: 1217-24. 15. Viitanen H, Baer G, Annila P. Recovery
  • characteristhics of sevoflurane or halatone for day-case
  • anaesthesia in children aged 1-3 years. Acta
  • Anaesthesiol Scand 2000; 44: 101-6. 16. Collins VJ. Intravenous anesthesia: Nonbarbiturates
  • nonnarcotics. In: Principal of anesthesiology general
  • and regional anesthesiology. Third edition,
  • Philadelphia: Lea&Febiger, 1993: 734-87. 17. Ostreikov IF, Vasil'ev IaI, Milenin VV, Pivovarov SS,
  • Babaev BD. Clinical picture of awekening after general
  • anesthesia with midazolam, propofol, ketamine and
  • fluothane in children treated at one-day ambulatory
  • facility. Anesteziol Reanimatol 2001; 1: 36-8 (Abstract). 18. Kabutan K, Doi Y, Takehisa S, Morimoto N, Taniguchi
  • M. Evaluation of the ketamine maintenance dose in
  • anesthesia using propofol, ketamine and nitrous oxide.
  • Masui 1999; 48: 534-6 (Abstract). nd
  • Yrd. Doç. Dr. Osman Nuri AYDIN
  • ADÜ Týp Fakültesi Anesteziyoloji ve Reanimasyon
  • A.D., 09100 AYDIN Tlf Faks GSM E-posta
  • : onaydin@superonline.com
  • Geliþ Tarihi : 02.03.2002
  • Kabul Tarihi : 16.04.2002
There are 69 citations in total.

Details

Other ID JA23VM29RM
Journal Section Research Article
Authors

Osman Nuri Aydın This is me

Bakiye Uğur This is me

Güner Erpek This is me

Sanem Özgün This is me

Publication Date April 1, 2002
Published in Issue Year 2002 Volume: 3 Issue: 1

Cite

EndNote Aydın ON, Uğur B, Erpek G, Özgün S (April 1, 2002) The effect of Induction by Subanesthetic dose of Ketamine on Recovery From Anesthesia. Meandros Medical And Dental Journal 3 1 19–23.