¹Assistant Professor, ^2,3Post Graduate, ⁴Associate Professor, Department of Anaesthesiology, Vinayaka Mission's Kirupananda Variyar Medical College & Hospital, VMRF (Deemed To Be), Salem, Tamil Nadu, INDIA.

Email: naveenasen@gmail.com, lathapurushotham@gmail.com, shiladityabs@gmail.com, marappansenthil@gmail.com

RESULTS

Age wise distribution were similar in both groups and duration of all procedures were less than 30 minutes

Table 1: Age wise distribution

The most common gynecological procedures that was done in both groups were dilatation and curettage and fractional curettage.

Table 2: Surgical procedures done among the study participants

Table 3: Comparison of study variables in two study group

Sedation score was similar in both groups after 1 minute after the induction of anesthesia. The sedation score was significantly higher in group A after 5 minutes of induction of anesthesia (P value<0.001). Postoperative recovery time was 5.51±0.77 in group A as compared to 4.73±0.74 in group B (P value<0.001). The additional dose requirement of propofol was 22.2% in group A and 48.8% in group B (P value<0.001). Delirium was seen in 16 patients in group B as compared to 3 in group A (P value<0.01). Positive Pressure Ventilation was needed for 3 patients in group A and vomiting was seen in 2 patients in group B, that was not statistically significant.

           Figure 1: Changes in Heart rate                                 Figure 2: Changes in mean arterial pressure

In figure 1, The baseline heart rate was similar in both groups, but after 1minute of post induction, the heart rate was significantly higher in group B as compared to group A (P value<0.001).

In figure 2, The baseline mean arterial pressure was similar in both groups, but was significantly higher in group B as compared to group A from 1 minute of post-induction(P value<0.001).

Table 4: Systemic hemodynamic parameters (values expressed as mean±SD)

T0-baseline, T1-1min after induction, T6-6 min after induction, T11- 11min after induction, T16- 16 min after induction, T1616 min after induction, T21-21 min after induction, T26-26 min after induction, T31-31 min after induction, SBP-systolic blood pressure, DBP diastolic pressure, HR-heart rate, Significant P.

DISCUSSION

Our study included 90 patients posted for short gynecological procedures, who were equally allocated to two groups,

Group A- Propofol 2.0mg/kg + Ketamine 1.0mg/kg and

Group B- propofol 1.0mg/kg + ketamine 1.0mg/kg.

Both groups were comparable to baseline characteristics and the duration of procedures. The most common gynecological procedure carried out were missed abortions and dysfunctional uterine bleeding. In the present study considering the hemodynamic parameters we found a rise of around 10% increase in both heart rate and MAP during first minute in group B which was statistically significant (P value<0.001). Similar observation of 10% higher hemodynamic parameters in patients of group B were seen during the period 20 to 30 minutes post injection.⁷ The increase in HR and MAP were not associated with any adverse cardiovascular effects. These results were similar to the data from the previous studies done by Jouguelet-Lacoste et al., Da Silva PS et al., Aouad MT et al. and Akin A et al.^7-9 where they had shown the increase of heart rate and the mean arterial pressure was quite obvious among the group which received lesser doses of propofol because of the cardio-respiratory depression role of the propofol and the sympatho-adrenal activation of the ketamine. Our study did not show any difference in the respiratory rate and SpO2 levels between these two groups. In the current study we found that the sedation score was higher and well maintained (Ramsay sedation score more than 5) throughout the procedure among the patients who received higher dose of propofol (group A) compared to the group which received a lower dose of propofol and this difference was found to be statistically significant (p<.05). Saeed et al. and Sharieff et al. had shown that ketofol in the ratio of 1:2 (ketamine 1mg/kg: propofol 2mg/kg) provided effective sedation with a higher sedation score and also with a rapid recovery profile.^10,11 In our study it was shown that among the patients who received the ketofol in the ratio of 1:2 only 3 patients required a positive pressure ventilation during the procedure and the difference was not found to be statistically significant. Hui and co-workers and Mortero and co-workers had also shown a similar type of findings in their study.^[12,13] The addition of low dose ketamine to propofol improves ventilation and reduces the risk of respiratory depression and also reduces the additional anesthetic drug requirement, which might be due to ketamine-induced sympathoadrenal activation.^14-16 Emergence reaction (delirium) during recovery in the form of confusion, shouting, hyperirritability, irrelevant talks and repeated tongue movements were noted in 6.6% in group A compared to 35.5% in group B and the difference was found to be statistically significant between the two groups. So a high dose combination of propofol with ketamine had shown a reduced incidence and intensity of emergency delirium which was on par with the studies by Mortero and co-workers and Sicignano and co-workers.^13,17 In the present study only 2 patients in group B developed vomiting and so it was found that nausea and vomiting did not show any statistical significant association between the groups. The additional dose requirement of propofol was 22.2% in group A and 48.8% in group B; This is because of the lesser dose of propofol given as loading dose in group B and the difference between the group was found to be statistically significant. In our study the post-operative recovery time in group A was higher (5.51 mins) compared to group B (4.73 mins) and the difference was found to be statistically significant (p value<0.001). This increase in the recovery time in group A is because of the higher dose of propofol given in group A.

CONCLUSION

Adequate analgesia and better hemodynamic parameters were seen in patients receiving a combination of propofol 2mg/kg +ketamine 1mg/kg as compared to patients who received Propofol 1mg/kg+ ketamine 1mg/kg for short gynecological procedures.

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