DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20151131

A comparative study of total intravenous anesthesia with propofol/ketamine and propofol/tramadol combinations in orthopedic outpatient procedures

Vashishta Kanchanpally, Panduranga Rao Nagawaram

Abstract


Background: Propofol opioid/nonopioid combinations provide adequate analgesia during and after surgery. The aim of this study was to compare the effect of anesthesia with propofol/ketamine versus propofol/tramadol on the haemodynamic parameters and pain in patients undergoing orthopaedic outpatient surgical procedures.

Methods: Fifty patients with ASA status I-II between the age group of 20-50 years undergoing orthopaedic outpatient surgical procedures under general anesthesia were randomly assigned to propofol/ ketamine (n=25, group I) and propofol/ tramadol (n=25, group II) groups. Patients in group I were induced with propofol 150 μg/kg/min IV and ketamine 50 μg/kg/min IV and in group II induction was performed with propofol 150 μg/kg/min IV and tramadol 1 mg/kg/min. IV. The hemodynamic parameters, oxygen saturation (SpO2), respiration rate, sedation and pain were measured before and after induction at predefined time points and were compared between groups.

Results: There was significant difference between groups in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR). SBP, DBP and HR were stable in patients induced with propofol/ketamine. The SBP, DBP and HR decreased significantly after induction with propofol/tramadol compared to premedication, but tends to return to normal after 25 minutes. No significant changes in SpO2 found in both the groups at all-time points. Both groups are sedated and showed no difference in pain score with few episodes of unpleasant dreams or hallucinations or adverse complications.

Conclusions: Propofol/tramadol anesthesia in patients undergoing orthopaedic procedures provided stable hemodynamic and respiratory stability, sedation and pain reduction as effective as propofol/ketamine anesthesia.


Keywords


Ketamine, Propofol, Tramadol, Total intravenous anesthesia

Full Text:

PDF

References


Mani V, Morton NS. Overview of total intravenous anesthesia in children. Paediatr Anaesth. 2010;20:211-22.

Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth. 2007;17:983-8.

Guit JB, Koning HM, Coster ML, Niemeijer RP, Mackie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia. 1991;46:24-7.

Bedirli N, Egritas O, Cosarcan K, Bozkirli F. A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy. Paediatr Anaesth. 2012;22:150-5.

Rajah A, Morgan M. Non-barbiturate drugs for the induction and maintenance of anaesthesia. Bailliere's Clinical Anaesthesiology. 1991;5:425-52.

Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation. Drugs. 1995;50:513-59.

Scottish Intercollegiate Guidelines Network. SIGN Guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Paediatr Anaesth. 2008;18:11-2.

Feld JM, Laurito CE, Beckerman M, Vincent J, Hoffman WE. Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can J Anaesth. 2003;50:336-41.

White PF, Ham J, Way WL, Trevor AJ. Pharmacology of ketamine isomers in surgical patients. Anesthesiology 1980;52:231-9.

Morse Z, Sano K, Kanri T. Effects of propofol-Ketamine admixture in human subjects. Pacific Health Dialog 2003;10:51-4.

Hosseinzadeh H, Eidy M, Golzari SE, Vasebi M. Hemodynamic Stability during Induction of Anesthesia in Elderly Patients: Propofol + Ketamine versus Propofol + Etomidate. J Cardiovasc Thorac Res. 2013;5:51-4.

Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43:879-923.

Lee CR, McTavish D, Sorkin EM. Tramadol. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs. 1993;46:313-40.

Vickers MD, O'Flaherty D, Szekely SM, Read M, Yoshizumi J. Tramadol: Pain relief by an opioid without depression of respiration. Anaesthesia. 1992;47:291-6.

Bedirli N, Egritas O, Cosarcan K, Bozkirli F. A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy. Paediatr Anaesth. 2012;22:150-5.

Kapral S, Gollmann G, Waltl B, Likar R, Sladen RN, Weinstabl C, et al. Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade. Anesth Analg. 1999;88:853-6.

Avramov MN, White PF. Methods for monitoring the level of sedation. Critical Care Clinics. 1995;11:803-26.

Felfernig M, Andel D, Weintraud M, Connor D, Andel H, Blaicher AM Postoperative vigilance in patients with total intravenous anaesthesia with ketamine/propofol. J R Nav Med Serv. 2006;92:64-8.

Joint National Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health, 2003.

Petersen KD, Landsfeldt U, Cold GE, Petersen CB, Mau S, Hauerberg J, et al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology. 2003;98:329-36.

Hans P, Bonhomme V. Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia. Curr Opin Anaesthesiol. 2006;19:49-503.

Deiner S. Highlights of anesthetic considerations for intraoperative neuromonitoring. Semin Cardiothorac Vasc Anesth. 2010;14:51-3.

Atluri S, Boswell MV, Hansen HC, et al. Guidelines for the use of controlled substances in the management of chronic pain. Pain Physician. 2003;6:233-57.

Singh Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol–ketamine and propofol–fentanyl. Saudi J Anaesth. 2010;4:72-9.

Kamalipour H, Joghataie P, Kamali K. Comparing the Combination Effect of Propofol-Ketamine and Propofol-Alfentanil on Hemodynamic Stability during Induction of General Anesthesia in the Elderly. Iranian Red Crescent Medical Journal IRCMJ. 2009;11:176-80.

Mayer M, Ochmann O, Doenicke A, Angster R, Suttmann H. The effect of propofol-ketamine anesthesia on hemodynamics and analgesia in comparison with propofol-fentanyl.Anaesthesist. 1990;39:609-16.

Rhoda Lee C, McTavish D, Sorkin EM. Tramadol: A Preliminary Review of its Pharmacodynamic and Pharmacokinetic Properties and Therapeutic Potential in Acute and Chronic Pain States. Drugs. 1993; 46:313-40.

Mortero RF, Clark LD, Tolan MM et al. The effects of small dose ketamine on propofol sedation: respiration, postoperative mood, perception, cognition, and pain. Anesth Analg. 2001;92 1465-9.

Morel DR, Forster A, Gemperle M. Noninvasive evaluation of breathing pattern and thoracoabdominal motion following infusion of ketamine or droperidol in humans. Anesthesiology. 1986;65:392-8.

Nimmaanrat S, Wasinwong W, Uakritdathikarn T. The analgesic efficacy of tramadol in ambulatory gynecological laparoscopic procedures: a randomized controlled study. Minerva Anestesiol. 2007;73:623-8.