Ideal anesthetic agents for day-care gynecological procedures: A clinical trial comparing thiopentone with ketamine as adjuncts to propofol

Authors

Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, India

Abstract

Background: Day-care gynecological procedures require the use of anesthetic agents, which ensure rapid induction and recovery. Although propofol is the gold standard drug in day-care procedures, it has its own side effects like apnea, cardiovascular instability, pain on injection, as well as its cost. The ideal drug combination to achieve this end remains elusive. Therefore, a combination of propofol, thiopentone, and ketamine may be a better alternative.
Materials and Methods: This prospective, double-blind, randomized study was conducted on 60 women, aged 18-50 years, American Society of Anesthesiologists (ASA) physical status 1 and 2, undergoing day-care gynecological surgeries. The patients were allocated to two groups. Group T received an admixture containing 10 ml of 1% propofol and 10 ml of 1.25% thiopentone. Group K received an admixture containing 10 ml of 1% propofol and 10 ml of 0.5% ketamine.
Results: There was less variation in the mean systolic blood pressure of patients in Group K as compared to patients in Group T. The mean total dose of propofol required in Group K (0.85 mg/kg) was significantly less than that required in Group T (1.12 mg/kg) (P = 0.0004). The mean recovery time in Group T (3.67 minutes) was significantly less than in Group K (6.27 minutes; P = 0.0001). However, the mean discharge time in both the groups was similar. (P = 0.7392). The results were analyzed statistically using the Student's t-test and the Fisher's exact test.
Conclusions: Both the propofol-thiopentone and propofol-ketamine admixtures provided adequate anesthesia. Propofol-ketamine proved superior to propofol-thiopentone in terms of hemodynamic stability and requirement of a lesser total dose of propofol. However, the patients in the propofol-thiopentone group had faster recovery.

Keywords

1.
Naguib M, Sari-Kouzel A. Thiopentone-propofol hypnotic synergism in patients. Br J Anaesth 1991;67:4-6.  Back to cited text no. 1
    
2.
Saha K, Saigopal M, Sundar R, Palniappan M, Mathew AC. Comparative evaluation of propofol-ketamine and propofol-fentanyl in minor surgery. Indian J Anaesth 2001;45:100-3.  Back to cited text no. 2
    
3.
Vora KS, Prabodhachandran MS, Bhosale GP, Singhal N, Parikh GP, Shah VR. Comparison of admixtures of propofol-thiopentone, propofol-ketamine and propofol in ambulatory surgery. J Anaesth Clin Pharmacol 2005;21:413-8.  Back to cited text no. 3
    
4.
Jones D, Prankerd R, Lang C, Chilvers M, Bignell S, Short T. Propofol-thiopentone admixture-hypnotic dose, pain on injection and effect on blood pressure. Anaesth Intensive Care 1999;27:346-56.  Back to cited text no. 4
    
5.
Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J. Additive interactions between propofol and ketamine when used for anesthesia induction in female patients. Anesthesiology 1995;82:641-8.  Back to cited text no. 5
    
6.
Begec Z, Demirbilek S, Onal D, Erdil F, Ilksen Toprak H, Ozcan Ersoy M. Ketamine or alfentanil administration prior to propofol anaesthesia: The effects on ProSeal laryngeal mask airway insertion conditions and haemodynamic changes in children. Anaesthesia 2009;64:282-6.  Back to cited text no. 6
    
7.
Badrinath S, Avramov MN, Shadrick M, Witt TR, Ivankovich AD. The use of ketamine-propofol combination during monitored anesthesia care. Anesth Analg 2000;90:858-62.  Back to cited text no. 7
    
8.
Saleem S, Ismat CW, Naaman K. An interventional comparative study of haemodynamic effects of induction doses of propofol-thiopentone and propofol-ketamine combinations. Anaesth Pain & Intensive Care 2010;14:82-7.  Back to cited text no. 8
    
9.
Tramèr MR, Moore RA, McQuay HJ. Propofol and bradycardia: Causation, frequency and severity. Br J Anaesth 1997;78:642-51.  Back to cited text no. 9
    
10.
Idvall J, Ahlgren I, Aronsen KR, Stenberg P. Ketamine infusions: Pharmacokinetics and clinical effects. Br J Anaesth 1979;51:1167-73.  Back to cited text no. 10
    
11.
Seltzer JL, Gerson JI, Allen FB. Comparison of the cardiovascular effects of bolus v. incremental administration of thiopentone. Br J Anaesth 1980;52:527-30.  Back to cited text no. 11
    
12.
Patrick RT, Faulconer A Jr. Respiratory studies during anesthesia with ether and with pentothal sodium. Anesthesiology 1952;13:252-74.  Back to cited text no. 12
    
13.
Goodman NW. Bimodality of expiratory time in patients anaesthetized with propofol. Br J Anaesth 1995;74:129-33.  Back to cited text no. 13
    
14.
White PF, Ham J, Way WL, Trevor AJ. Pharmacology of ketamine isomers in surgical patients. Anesthesiology 1980;52:231-9.  Back to cited text no. 14
    
15.
Sinha R, Shende D, Garg R. Comparison of propofol (1%) with admixture (1:1) of thiopentone (1.25%) and propofol (0.5%) for laryngeal mask airway insertion in children undergoing elective eye surgery: Double-masked randomized clinical trial. Indian J Anaesth 2010;54:104-8.  Back to cited text no. 15
    
16.
Lee TW, Loewenthal AE, Strachan JA, Todd BD. Pain during injection of propofol. The effect of prior administration of thiopentone. Anaesthesia 1994;49:817-8.  Back to cited text no. 16
    
17.
Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia 1998;53:302-5.  Back to cited text no. 17
    
18.
Borgeat A, Wilder-Smith OH, Suter PM. The nonhypnotic therapeutic applications of propofol. Anesthesiology 1994;80:642-56.  Back to cited text no. 18
    
19.
Gan TJ, Glass PS, Howell ST, Canada AT, Grant AP, Ginsberg B. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology 1997;87:779-84.  Back to cited text no. 19
    
20.
Gan TJ, Ginsberg B, Grant AP, Glass PS. Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology 1996;85:1036-42.  Back to cited text no. 20
    
21.
Gorchynski J, Wang S, Anderson C, Montano J. Conscious sedation and emergency department length of stay: A comparison of propofol, ketamine and fentanyl/versed. Cal J Emerg Med 2006;7:4-7.  Back to cited text no. 21