Padhi Pulak P, Yeeda Sirisha, Nayak Laba K, Das Saswati
Department of Anesthesia, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT) Deemed to be University, Bhubaneswar, IND.
Department of Anesthesia, Manipal Hospitals, Guntur, IND.
Cureus. 2022 Jan 18;14(1):e21393. doi: 10.7759/cureus.21393. eCollection 2022 Jan.
Procedural sedation with a combination of propofol and ketamine for short-duration surgeries is a convenient technique of anesthesia as it has a faster recovery avoiding the side effects of general anesthesia. The aim of this study was to compare the sedative and analgesic effects of two different proportions of ketamine and propofol combination in patients undergoing short gynecological procedures.
A randomized double-blind study was conducted in 140 patients posted for elective gynecological procedures with a duration equal to or less than 30 minutes. After premedication of all participants, sedation was induced with bolus administration (0.1 mL/kg) of the study drugs to achieve desired Ramsay sedation score (RSS) of 6, followed by infusion at 0.3 mL/kg/h (Group A, ketamine:propofol in the ratio of 1:4 and Group B, ketamine:propofol in the ratio of 1:2). The adequacy of sedation, volume of drug to induce the patient, time to achieve desired RSS, time for first bolus dose, the total volume of the drugs, hemodynamic variables, awakening time, and side effects were observed.
The incidence of movement of lower extremities was found to be significantly lower in the higher concentration ketamine group (Group B, P - 0.028). The volume of a drug for induction and the duration to reach RSS of 6 were significantly lower in Group B with P-values of 0.002 and <0.001, respectively. Hemodynamic variables, awakening time, and side effects were not statistically significant between the two groups.
Ketamine-propofol combination in the ratio 1:2 provides better sedation and analgesia with no increased side-effects compared to ketamine-propofol in the ratio 1:4 for short outpatient gynecological procedures.
丙泊酚和氯胺酮联合用于短期手术的程序镇静是一种便捷的麻醉技术，因为其恢复更快，可避免全身麻醉的副作用。本研究的目的是比较两种不同比例氯胺酮和丙泊酚联合用药在接受短期妇科手术患者中的镇静和镇痛效果。
对140例计划进行时长等于或少于30分钟的择期妇科手术患者进行了一项随机双盲研究。在所有参与者进行术前用药后，通过静脉推注（0.1 mL/kg）研究药物诱导镇静，以达到目标Ramsay镇静评分（RSS）为6，随后以0.3 mL/kg/h的速度输注（A组，氯胺酮：丙泊酚比例为1:4；B组，氯胺酮：丙泊酚比例为1:2）。观察镇静的充分性、诱导患者所需的药物量、达到目标RSS的时间、首次推注剂量的时间、药物总量、血流动力学变量、苏醒时间和副作用。
发现高浓度氯胺酮组（B组）下肢运动发生率显著更低（P = 0.028）。B组诱导用药量和达到RSS为6的持续时间显著更低，P值分别为0.002和<0.001。两组之间的血流动力学变量、苏醒时间和副作用无统计学差异。
对于短期门诊妇科手术，氯胺酮与丙泊酚比例为1:2的联合用药比氯胺酮与丙泊酚比例为1:4的联合用药提供更好的镇静和镇痛效果，且副作用未增加。
