Women's Reproductive Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):247-50. doi: 10.1016/j.ejogrb.2013.06.026. Epub 2013 Jul 17.
Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient procedures because of its rapid onset, short duration of action and smooth patient awakening. However, propofol has various cardiovascular effects such as reduced arterial pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic and short-acting analgesic that could alleviate the haemodynamic effects of propofol due to its sympathomimetic activity. The aim of this placebo-controlled trial was to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia in DGL.
In this double-blind randomized trial, 60 healthy women undergoing gynaecological laparoscopy to investigate infertility were studied. Following injection of midazolam and fentanyl in all patients, the study group (n=30) received ketamine 0.5 mg/kg and propofol 1-2.5 mg/kg, and the placebo group (n=30) received saline 0.9% and propofol 1-2.5 mg/kg. Propofol was subsequently infused for the maintenance of anaesthesia.
Patients in the study group had a significantly lower incidence of pain than patients in the placebo group during propofol injection (13% vs 87%, respectively; p<0.0001). After induction of anaesthesia, 16 (53%) patients in the placebo group and three (10%) patients in the study group had a decreased heart rate (p<0.001). The decrease in mean arterial pressure was greater in the placebo group compared with the study group (37% vs 7%, respectively; p<0.001). During the procedure, the total mean±standard deviation dose of propofol was 420±65 mg in the placebo group and 330±35 mg in the study group (p<0.001). Pain scores for the first 3h after the operation were significantly lower in the study group (p<0.001).
Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing DGL was associated with less pain during propofol injection, lower incidence of haemodynamic changes, lower total dose of propofol and improved postoperative analgesia.
诊断性妇科腹腔镜检查（DGL）是一种简短的程序，通常在门诊进行。由于其起效迅速、作用时间短、患者苏醒平稳，丙泊酚-芬太尼常被用于门诊小手术的麻醉。然而，丙泊酚具有降低动脉压、心输出量和心指数等各种心血管作用。氯胺酮是一种静脉麻醉药和短效镇痛药，由于其拟交感神经活性，可减轻丙泊酚的血流动力学效应。本安慰剂对照试验的目的是评估在 DGL 中添加小剂量氯胺酮对丙泊酚-芬太尼麻醉的影响。
在这项双盲随机试验中，对 60 名接受妇科腹腔镜检查以调查不孕的健康女性进行了研究。所有患者均注射咪达唑仑和芬太尼后，研究组（n=30）给予氯胺酮 0.5mg/kg 和丙泊酚 1-2.5mg/kg，安慰剂组（n=30）给予生理盐水 0.9%和丙泊酚 1-2.5mg/kg。随后输注丙泊酚维持麻醉。
与安慰剂组（分别为 13%和 87%；p<0.0001）相比，研究组患者在丙泊酚注射期间疼痛发生率显著降低。麻醉诱导后，安慰剂组 16（53%）例患者和研究组 3（10%）例患者出现心率下降（p<0.001）。与研究组相比，安慰剂组平均动脉压下降更大（分别为 37%和 7%；p<0.001）。手术过程中，安慰剂组的丙泊酚总平均±标准差剂量为 420±65mg，研究组为 330±35mg（p<0.001）。术后 3 小时内，研究组疼痛评分显著降低（p<0.001）。
在接受 DGL 的患者中，丙泊酚-芬太尼麻醉中使用小剂量氯胺酮与丙泊酚注射时疼痛减轻、血流动力学变化发生率降低、丙泊酚总剂量降低以及术后镇痛改善有关。
