Raman Vikasini, Segaran Sivakumar, Ramyavel T, George Sagiev Koshy, Zachariah Mamie
Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, India.
J Anaesthesiol Clin Pharmacol. 2022 Apr-Jun;38(2):215-220. doi: 10.4103/joacp.JOACP_251_20. Epub 2022 Jan 13.
Laparoscopic surgeries are more commonly performed procedure nowadays because of its advantages however generation of pneumoperitoneum causes significant physiological changes. Propofol is the most commonly used induction agent but its use is limited by its side effects like dose-dependent hypotension and myocardial depression. So by combining propofol with ketamine to form ketofol may result in better hemodynamic stability. The aim of this study was to compare the haemodynamic changes in patients undergoing laparoscopic surgery under general anesthesia using propofol and ketofol as induction agents.
In this prospective randomized double blind study, 80 patients of ASA I/II undergoing elective laparoscopic surgery were randomized into two Groups. Group A received 1 mg/kg of propofol + 1 mg/kg ketamine made up to a total volume of 20 ml with normal saline and Group B received 2 mg/kg propofol + normal saline to make up to an equal volume. Hemodynamic profiles like HR, SBP, DBP, and MAP were recorded at different time intervals until pneumoperitoneum. Postoperative recovery profile and complications were recorded. All data were entered in MS excel and analyzed using SPSS Version 20.0. Repeated measures ANOVA and Chi-square test were used to test the level of significance.
Demographic character and duration of surgery were comparable. SBP, DBP, MAP and HR showed statistically significant difference in both groups in various time intervals with P < 0.05 with Group A (ketofol ) having a better hemodynamic stability. Recovery profile in ketofol group took longer duration (4.95 min) compared to propofol group B (1.8 min). Postoperative nausea and vomiting were significant (P = 0.004) in ketofol group.
We concluded that ketofol had a better hemodynamic stability compared to propofol as an induction agent, however time for recovery in ketofol group took a longer period compared to propofol group, with no complication in either groups.
由于具有诸多优势,腹腔镜手术如今更为常用,然而气腹的形成会引发显著的生理变化。丙泊酚是最常用的诱导剂,但其使用受到诸如剂量依赖性低血压和心肌抑制等副作用的限制。因此,将丙泊酚与氯胺酮联合形成氯胺酚可能会带来更好的血流动力学稳定性。本研究的目的是比较在全身麻醉下接受腹腔镜手术的患者使用丙泊酚和氯胺酚作为诱导剂时的血流动力学变化。
在这项前瞻性随机双盲研究中,80例接受择期腹腔镜手术的ASA I/II级患者被随机分为两组。A组接受1mg/kg丙泊酚 + 1mg/kg氯胺酮,用生理盐水补足至总体积20ml,B组接受2mg/kg丙泊酚 + 生理盐水补足至相同体积。在气腹形成前的不同时间间隔记录心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)等血流动力学参数。记录术后恢复情况和并发症。所有数据录入MS Excel并使用SPSS 20.0版进行分析。采用重复测量方差分析和卡方检验来检验显著性水平。
人口统计学特征和手术时长具有可比性。两组在不同时间间隔的SBP、DBP、MAP和HR显示出统计学上的显著差异(P < 0.05),A组(氯胺酚)具有更好的血流动力学稳定性。氯胺酚组的恢复时间(4.95分钟)比丙泊酚组B(1.8分钟)更长。氯胺酚组术后恶心和呕吐情况显著(P = 0.004)。
我们得出结论,作为诱导剂,氯胺酚比丙泊酚具有更好的血流动力学稳定性,然而氯胺酚组的恢复时间比丙泊酚组长,两组均无并发症。