Abstract
Objectives
Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed
on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient
procedures because of its rapid onset, short duration of action and smooth patient
awakening. However, propofol has various cardiovascular effects such as reduced arterial
pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic
and short-acting analgesic that could alleviate the haemodynamic effects of propofol
due to its sympathomimetic activity. The aim of this placebo-controlled trial was
to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl
anaesthesia in DGL.
Study design
In this double-blind randomized trial, 60 healthy women undergoing gynaecological
laparoscopy to investigate infertility were studied. Following injection of midazolam
and fentanyl in all patients, the study group (n = 30) received ketamine 0.5 mg/kg and propofol 1–2.5 mg/kg, and the placebo group (n = 30) received saline 0.9% and propofol 1–2.5 mg/kg. Propofol was subsequently infused for the maintenance of anaesthesia.
Results
Patients in the study group had a significantly lower incidence of pain than patients
in the placebo group during propofol injection (13% vs 87%, respectively; p < 0.0001). After induction of anaesthesia, 16 (53%) patients in the placebo group and
three (10%) patients in the study group had a decreased heart rate (p < 0.001). The decrease in mean arterial pressure was greater in the placebo group compared
with the study group (37% vs 7%, respectively; p < 0.001). During the procedure, the total mean ± standard deviation dose of propofol was 420 ± 65 mg in the placebo group and 330 ± 35 mg in the study group (p < 0.001). Pain scores for the first 3 h after the operation were significantly lower in the study group (p < 0.001).
Conclusion
Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing
DGL was associated with less pain during propofol injection, lower incidence of haemodynamic
changes, lower total dose of propofol and improved postoperative analgesia.
Keywords
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Article info
Publication history
Published online: July 08, 2013
Accepted:
June 24,
2013
Received in revised form:
February 27,
2013
Received:
October 30,
2012
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
