1
|
Okeyemi A, Suleiman AZ, Oyedepo OO, Bolaji BO, Adegboye BM, Ige OA. Comparative study of haemodynamic effects of intravenous ketamine-fentanyl and propofol-fentanyl for laryngeal mask airway insertions in children undergoing herniotomy under general anaesthesia in a nigerian tertiary hospital. Niger Postgrad Med J 2022; 29:36-42. [PMID: 35102948 DOI: 10.4103/npmj.npmj_753_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Insertion of laryngeal mask airway (LMA) with propofol in children may cause hypotension, laryngospasm and apnoea. Ketamine and fentanyl have been combined separately with propofol to prevent depression of cardiovascular system during LMA insertion, especially in paediatric patients. Ketamine-fentanyl and propofol-fentanyl combinations have analgesic effect, prevent coughing and apnoea and regarded as agents of choice for LMA insertions. However, the cardiovascular effects of the two admixtures for LMA insertions have not been fully assessed in children. We compared the haemodynamic effects of ketamine-fentanyl and propofol-fentanyl combinations for LMA insertion in paediatric patients who underwent herniotomy in our facility. PATIENTS AND METHODS This comparative study was conducted on 80 children aged 1-15 years, ASA physical Statuses I and II, who had herniotomy under general anaesthesia. The patients were randomised into two groups (A and B) of 40 patients each and LMA was inserted following administrations of the two different drug combinations. Patients in Group A received pre-mixed ketamine 2 mg/kg and fentanyl 2 μg/kg while the patients in Group B received pre-mixed propofol 2.5 mg/kg and fentanyl 2 μg/kg. The blood pressure and incidence of apnoea were determined in the two groups during and after the LMA insertion. RESULTS The haemodynamic states of the patients were not comparable statistically as the heart rate, systolic, diastolic and mean arterial blood pressure were significantly higher and stable in the ketamine-fentanyl group than the propofol-fentanyl group (P < 0.05). The incidence of apnoea was significantly lower in the ketamine-fentanyl group compared with propofol-fentanyl group (P = 0.045), but post-anaesthesia discharge scores were similar, with no significant difference in both groups (P = 0.241). CONCLUSION The use of ketamine-fentanyl combination for LMA insertion in paediatric patients was associated with better haemodynamic changes and lower incidence of apnoea when compared with propofol-fentanyl combination.
Collapse
Affiliation(s)
- Ajibade Okeyemi
- Department of Anaesthesia and Intensive Care, Federal Medical Centre, Owo, Ondo State; Department of Anaesthesia and Intensive Care, Afebabalola University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Aliyu Zakari Suleiman
- Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Benjami Olusomi Bolaji
- Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Olufemi Adebayo Ige
- Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| |
Collapse
|
2
|
Shafa A, Shahhosseini S, Rajaee E. Comparison of Two Dosages of Ketamine in Preventing Fentanyl-Induced Coughs in Children. Adv Biomed Res 2021; 10:20. [PMID: 34476228 PMCID: PMC8378446 DOI: 10.4103/abr.abr_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/20/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fentanyl is a short-acting drug used to induce anesthesia. Here, we aimed to compare the two doses of ketamine to prevent fentanyl-induced cough in children under general anesthesia. MATERIALS AND METHODS This is a randomized, clinical trial which was performed in 2019 in Imam Hossein Hospital in Isfahan, Iran. The study population consisted of children between 6 months and 2 years who were candidates for general anesthesia. Patients were randomized into three groups, each containing 31 patients. Groups 1 and 2 received 0.1 mg/kg and 0.2 mg/kg intravenous ketamine, respectively, 1 min before fentanyl injections. Group 3 received the same volumes of normal saline 0.9%. Patients were observed and evaluated for the incidence and intensity of coughs 1 min and 3 min after fentanyl injections. RESULTS We showed that the frequency of coughs 1 min after fentanyl injection was significantly lower in Group 2 compared to other groups (P < 0.001). Three min after fentanyl injection, the frequencies of coughs were significantly lower in Groups 1 and 2 compared to Group 3 (P < 0.001). We also showed that the intensity of coughs was significantly lower in Group 2 compared to other Groups 1 and 3 min after fentanyl injection (P < 0.001). CONCLUSION The administration of 0.2 mg/kg ketamine is more effective than 0.1 mg/kg dosage in the prevention of fentanyl-induced cough. We also showed that this method could bring more stable hemodynamics and oxygenation saturation inpatients. The comparison of the two dosages was a novel issue in the recent literature.
Collapse
Affiliation(s)
- Amir Shafa
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedighe Shahhosseini
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Rajaee
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
3
|
Ali WA, Aboelhussein AK, Fahmy MM. Evaluation of ketamine versus midazolam as co-induction agents with propofol for laryngeal mask airway insertion in children. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1807839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Wegdan A. Ali
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Minia University, Minya, Egypt
| | - Amany K. Aboelhussein
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Minia University, Minya, Egypt
| | - Marwa M. Fahmy
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Minia University, Minya, Egypt
| |
Collapse
|
4
|
Yin S, Hong J, Sha T, Chen Z, Guo Y, Li C, Liu Y. Efficacy and Tolerability of Sufentanil, Dexmedetomidine, or Ketamine Added to Propofol-based Sedation for Gastrointestinal Endoscopy in Elderly Patients: A Prospective, Randomized, Controlled Trial. Clin Ther 2019; 41:1864-1877.e0. [DOI: 10.1016/j.clinthera.2019.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/07/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
|
5
|
Aberra B, Aregawi A, Teklay G, Tasew H. Effect of ketofol versus propofol as an induction agent on ease of laryngeal mask airway insertion conditions and hemodynamic stability in pediatrics: an observational prospective cohort study. BMC Anesthesiol 2019; 19:41. [PMID: 30894140 PMCID: PMC6425569 DOI: 10.1186/s12871-019-0711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 03/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background Laryngeal mask airway is a supraglottic airway device which has led to a fundamental change in the management of modern general anesthesia. In the present study; we evaluated the laryngeal mask airway insertion conditions and hemodynamic changes comparing ketamine-propofol mixture (ketofol) with propofol. The study was to compare the ketamine–propofol mixture (ketofol) with propofolon the ease of laryngeal mask airway insertion conditions and hemodynamic effects for induction of general anesthesia. Methods One hundred twenty pediatric patients were recruited and assigned to two groups (60 each). Group KP = ketofol, group P = propofol. Insertion conditions were compared using a Chi-square test while hemodynamic variables were compared using the independentt-test. Statistical significance was stated at p-value< 0.05. Results Laryngeal mask airway insertion summed score was nearly similar between the two groups. Mean blood pressure and heart rate were maintained higher in ketofol group while a significant drop was observed in the propofol group. The time from the Laryngeal mask airway placement to the return of spontaneous ventilation was significantly longer in propofol group (240 s [range = 60–360 s]) compared with ketofol group (180 s [range = 30–320 s]) (p = 0.005). Conclusions Laryngeal mask airway insertion condition summed score was comparable in both ketofol and propofol group. Ketofol provided equivalent laryngeal mask airway insertion conditions while maximizing hemodynamics and minimizing apnea time. Ketofol can be used as an alternative to propofol for laryngeal mask airway insertion in pediatrics.
Collapse
Affiliation(s)
- Bacha Aberra
- Aksum University, PO box 298, Aksum City, Tigray, Ethiopia.
| | - Adugna Aregawi
- Addis Ababa University, PO box 811/1000, Addis Ababa, Ethiopia
| | - Girmay Teklay
- Aksum University, PO box 298, Aksum City, Tigray, Ethiopia
| | - Hagos Tasew
- Aksum University, PO box 298, Aksum City, Tigray, Ethiopia
| |
Collapse
|
6
|
Kılıc E, Demiriz B, Isıkay N, Yıldırım AE, Can S, Basmacı C. Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients. Saudi Med J 2017; 37:1191-1195. [PMID: 27761556 PMCID: PMC5303795 DOI: 10.15537/smj.2016.11.14557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). Methods: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. Conclusion: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.
Collapse
Affiliation(s)
- Ertugrul Kılıc
- Department of Anesthesiology, Şehitkamil State Hospital, Gaziantep, Turkey. E-mail.
| | | | | | | | | | | |
Collapse
|
7
|
Gholipour Baradari A, Firouzian A, Zamani Kiasari A, Aarabi M, Emadi SA, Davanlou A, Motamed N, Yousefi Abdolmaleki E. Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial. Anesth Pain Med 2016; 6:e30071. [PMID: 27110526 PMCID: PMC4834424 DOI: 10.5812/aapm.30071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 09/17/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances. OBJECTIVES The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation. PATIENTS AND METHODS In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured. RESULTS A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents. CONCLUSIONS Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted.
Collapse
Affiliation(s)
- Afshin Gholipour Baradari
- Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abolfazl Firouzian
- Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author: Abolfazl Firouzian, Department of Anaesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-1133224488, Fax: +98-1133275038, E-mail:
| | - Alieh Zamani Kiasari
- Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohsen Aarabi
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Abdollah Emadi
- Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Davanlou
- Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nima Motamed
- Department of Community Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | |
Collapse
|
8
|
Abbasivash R, Aghdashi MM, Sinaei B, Kheradmand F. The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response. J Clin Anesth 2014; 26:628-33. [PMID: 25439407 DOI: 10.1016/j.jclinane.2014.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent. DESIGN Prospective, double-blinded, randomized controlled trial. SETTING Operating room of a university hospital. PATIENTS 60 ASA physical status 1 and 2 patients scheduled for limited elective surgery requiring general anesthesia. INTERVENTIONS Patients were randomized to two groups to receive etomidate 0.3 mg/kg (single-drug group) or propofol 0.6 mg/kg + ketamine 0.8 mg/kg + midazolam 0.06 mg/kg (three-drug group). MEASUREMENTS Hemodynamic responses (systolic and diastolic blood pressure, and mean arterial pressure) were examined at baseline and at one, three, and 5 minutes after tracheal intubation. Plasma catecholamine levels were measured at baseline, one, and 5 minutes after tracheal intubation. MAIN RESULTS Heart rate (HR) changes differed significantly between the two groups at three minutes (P = 0.01) and 5 minutes (P = 0.00) after tracheal intubation. However, the HR increase in the three-drug group was in the acceptable range. Percentage changes of epinephrine level differed between the two groups at 5 minutes after tracheal intubation (P = 0.03). CONCLUSIONS The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.
Collapse
Affiliation(s)
- Rahman Abbasivash
- Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mir Moosa Aghdashi
- Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Behzad Sinaei
- Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Fatemeh Kheradmand
- Department of Biochemistry, Center for Cellular and Molecular Research, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
| |
Collapse
|
9
|
Schwartz D, Begley A, Gibson C, Visintainer P, Connelly NR. Laryngeal mask airway placement in children prior to an intravenous line utilizing heart rate as an indicator of anesthetic depth. Paediatr Anaesth 2014; 24:1044-9. [PMID: 25040081 DOI: 10.1111/pan.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The usual practice in pediatric anesthesia cases requiring a laryngeal mask airway is to place an intravenous line (IV) prior to laryngeal mask airway placement. A different approach that has several clinical advantages is to place the laryngeal mask airway prior to the IV. We describe our experience with this technique, using heart rate as an indicator of adequate anesthetic depth. In addition, we analyzed heart rate data in children undergoing sevoflurane inductions, looking for age-related differences. METHODS Following a sevoflurane induction, heart rates were recorded every 12 s for 3 min in 127 ASA I-II children under age 7. Laryngeal mask airway placement occurred when the heart rate dropped at least 10% from its maximum level or at 3 min. Ease of laryngeal mask airway placement was graded using a scale from 0 to 3. Endtidal sevoflurane concentration, occurrence of laryngospasm and blood pressure at laryngeal mask airway placement were also recorded. RESULTS The laryngeal mask airway was successfully placed on the first attempt in all 127 children. Easy placement was noted in 98.4%. The youngest children's heart rates peaked earlier than the oldest (P < 0.001), while time to laryngeal mask airway placement increased with increasing age (P < 0.0001). CONCLUSIONS Laryngeal mask airway placement before an IV is a safe alternative to the usual mask-IV-laryngeal mask airway sequence. Our data compare favorably to other studies where ease of laryngeal mask airway placement was reported. This technique has several advantages including securing the airway first for an anticipated difficult IV placement. Heart rate changes during a sevoflurane induction appear to be age-dependent.
Collapse
Affiliation(s)
- Donald Schwartz
- Department of Anesthesiology, Baystate Medical Center, Springfield, MA, USA
| | | | | | | | | |
Collapse
|
10
|
Jarahzadeh MH, Jouya R, Mousavi FS, Dehghan-tezerjani M, Behdad S, Soltani HR. Propofol or Thiopental sodium in patients undergoing reproductive assisted technologies: Differences in hemodynamic recovery and outcome of oocyte retrieval: A randomized clinical trial. IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE 2014; 12:77-82. [PMID: 24799865 PMCID: PMC4009585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/31/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thiopental sodium and Propofol are two widely-used drugs in the induction of anesthesia in assisted reproductive technology (ART). However, the side effects and outcome of recovery from anesthesia of these drugs on ART have not been identified yet. OBJECTIVE This study aimed at investigating the side effects and hemodynamic effects of using thiopental sodium and propofal as well as effects of these drugs on pregnancy outcome in ART cycles. MATERIALS AND METHODS In this double blinded) randomized controlled trial, 90 woman candidate for ART were randomly divided into two groups. 47 patients received Propofol (2.5 mg/kg) and 43 patients received thiopental (5mg/kg) for anesthesia induction. The entry hemodynamic parameters of the patients were documented. During the anesthesia process, hemodynamic parameters were checked at five-minute intervals. RESULTS The results of the study showed a statistically significant difference between two groups in terms of their response to verbal stimulation (p<0.001), the normalization time of the rate and quality of breathing (p<0.001), nausea (p<0.001), and vomiting (p<0.001). Also, in comparison with the other group, all these parameters were better in Propofol group. There was found no significant difference between two groups in terms of other variables. CONCLUSION Based on the findings of the study, Propofol has fewer known side effects. Vomiting and nausea as two known side effect of anesthesia are significantly lower in patients receiving Propofol than patients who received thiopental. REGISTRATION ID IN IRCT IRCT201303135393N2 This article extracted from M.D. thesis. (Reza Jouya).
Collapse
Affiliation(s)
- Mohammad Hossein Jarahzadeh
- Department of Anesthesiology and Critical Care, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Reza Jouya
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fatemeh Sadat Mousavi
- Department of Anesthesiology and Critical Care, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mohammad Dehghan-tezerjani
- Department of Anesthesiology and Critical Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Shekoofa Behdad
- Department of Anesthesiology and Critical Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Hamid Reza Soltani
- Scientific Society of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran.
| |
Collapse
|