Which sedation method is appropriate for spinal anesthesia: propofol or ketamine-propofol combination
Abstract
Background and objective: Spinal anesthesia is a preferred method in daily practice as it provides muscle relaxation and maintains spontaneous respiration during surgical procedures. Opiods, midazolam, ketamine, propofol and dexmedetomidine are the generally preferred sedoanalgesic agents. Ketofol, a mixture of ketamine and propofol, is a good analgesic and also provides sedation even at low doses.
Methodology: 54 inguinal hernia surgery patients were included and divided into two groups: propofol group (Group P, n: 27) and ketofol group (Group KP, n: 27). The ketofol mixture was obtained by mixing 2 ml of ketamine (50 mg/ml) with 8 ml saline and then adding 10 ml of propofol (%1, 10 mg/ml) to acquire a solution of 5mg/ml ketamine and 5 mg/ml propofol. The Ramsay sedation scale (RSS) and bispectral index (BIS) were used to determine the response to sedation and analgesia. Intraoperative hemodynamic parameters and medication dosages were recorded. At postoperative 12th hour visual analog scale (VAS) was performed to measure patient satisfaction and pain.
Results: Although the duration of surgery was similar in both groups, the duration
in intensive care unit was significantly longer in Group P (p:0.002, Table 1). The time
taken to reach Ramsay 3 value was significantly shorter in Group KP than in
Group P (6.8 ± 5.1 vs 9.6 ± 7.2 minutes, p:0.042). Group KP patients were also highly satisfied and experienced less pain in postoperative period according to VAS evaluation (p: 0.04).
Conclusion: Ketofol is a good alternative for propofol in spinal anesthesia for regional surgeries with higher postoperative patient satisfaction, lower pain rates and shorter intensive care requirements.
Citation: Güleç H, Tutal ZB, Şahap M, Babayiğit M, İnceöz H, Kurtay A, Horasanlı E. Which Sedation is more Appropriate during Spinal Anesthesia: Propofol or Ketamine-Propofol Combination? Anaesth Pain & Intensive Care 2015;19(1):28-32
