A COMPARATIVE STUDY OF INDUCTION WITH LOW DOSE KETAMINE-PROPOFOL VERSUS FENTANYLPROPOFOL IN ATTENUATING THE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Ismatara Begum, Ranadhee Paul, Deba Gopal Pathak

Abstract


Background and Aims: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. This study was conducted to compare the effect of two drug combinations using ketamine-propofol and fentanyl-propofol in attenuating haemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia, duration of analgesia and side effects if any. Methods: After taking ethical committee clearance a randomized single blind prospective study involving 100 patients(18-60 years)of ASA-I and II undergoing GA for elective surgeries, were divided into 2 groups: Group K received Inj.Ketamine 0.5 mg/kg+inj.Propofol 2 mg/kg, Group F received Inj.Fentanyl 1.0 μg/kg+inj.Propofol 2 mg/kg. Haemodynamic parameters HR, SBP and DBP were recorded at baseline, after study drug, at 1min, 3min, 5 min, 10 min, 20 min after intubation and so on till completion of surgery. Pain score was assessed by Visual Analogue Scale (VAS) score. Student’s unpaired t-test and chi-square test tests were used for statistical analysis. Results: Upon induction with study drugs there was fall in SBP and DBP in both the groups but more in group F (p-value<0.0204 for SBP, p-value<0.0002 for DBP). On induction HR reduced in group F but it was slightly raised in group K (p-value<0.0001). After endotracheal intubation, at 1 minute, BP and HR increased significantly and reached above the baseline in group K but it remained below the baseline in group F(p-value<0.0001for HR and DBP,p-value<0.0158 for SBP). During maintenance phase group K showed more stable haemodynamics as compared to group F. The mean duration analgesia is significantly shorter 83.1 ± 10.814 mins for Group F and for Group K it is 91.64 ± 8.998 mins (P value< 0.0001). Conclusion: Fentanyl is superior to Ketamine in attenuating haemodynamic response to laryngoscopy and intubation. The duration of analgesia was shorter and rescue analgesia requirement was earlier in fentanyl group as compared to ketamine group and few untoward side effects were seen in both the groups.


Keywords


Propofol-ketamine, propofol-fentanyl, haemodynamic attenuation, laryngoscopy and intubation.

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