A Comparative Study of Propofol-Ketamine and Propofol-Fentanyl for Total Intravenous Anaesthesia

Author(s): Pavani Sudhamala1 , Kousalya Chakravarthy2

BACKGROUND Total Intravenous Anaesthesia (TIVA) is a modified form of general anaesthesia where induction as well as maintenance of anaesthesia is with intravenous agents alone. We aim to compare the drug combinations of Propofol-Ketamine and Propofol-Fentanyl in total intravenous anaesthesia. METHODS A prospective randomized study was conducted on 100 female subjects between 20 to 50years, posted for minor day-care gynaecological surgeries. The subjects were randomly allocated into 2 groups Propofol-Ketamine (PK) group and Propofol-Fentanyl (PF) group. Those in PK group were induced with Propofol 1 mg/Kg and Ketamine 1 mg/Kg and anaesthesia was maintained with Propofol infusion 2 mg/Kg/hr and Ketamine infusion 2 mg/Kg/hr. Patients in PF group were induced with Propofol 1 mg/Kg and Fentanyl 2µg/Kg and anaesthesia was maintained with Propofol infusion 2 mg/Kg/hr and fentanyl infusion 2µ/Kg/hr. Mean pulse rate, systolic and diastolic blood pressures, saturations (SpO2) and respiratory rate (RR) were measured immediately after induction and at intervals of 1, 3, 5, 10, 20, 30 minutes of intraoperative period. Vitals immediately after surgery and in post-operative period were compared in both the groups at 15min interval for 1hour, along with the sedation and recovery scores in the postoperative period. RESULTS Demographic data were comparable in both the groups. The mean pulse rate, systolic, diastolic blood pressures immediately after induction were significantly more in group PK when compared to group PF (p<0.05). Statistically significant difference was not seen in the mean saturations (SpO2) in the intraoperative period, immediately after surgery and 15 minutes after surgery. Mean RR was significantly higher in PK group as compared to group PF in the intraoperative and immediate postoperative periods. The mean sedation score was more in group PK than in group PF immediately after surgery and at 15minutes after surgery (P=0.001). The recovery score was slightly higher and recovery time was less in PF group. In group PK, 2 patients had post-operative excitation, 4 patients had secretions and 1 patient complained of post-operative nausea. In the PF group 3 patients had post-operative nausea. CONCLUSIONS In conclusion, Propofol-Ketamine and Propofol-Fentanyl combinations produce comparable rapid and safe anaesthesia with minor hemodynamic fluctuations and few side effects. Recovery score and recovery time were better in propofolfentanyl group compared to propofol-ketamine group.