Target controlled infusion of ketamine as analgesia for TIVA with propofol

Abstract

Target controlled infusion of ketamine as analgesia for TIVA with propofol I~.,'po~: To determine the accuracy of a target controlled infusion system for ketamine and to assess its suitability for the provision of analgesia when used in conjunction with a propofol infusion in spontaneously breathing patients. Methods: Nineteen, adult, ASA I-II patients scheduled for elective surgery were studied. After premedication with 20 mg temazepam an appropriate plasma concentration of ketamine was selected and, when the target controlled infusion (TCI) system indicated that this had been achieved, anesthesia was induced and maintained using a propofol infusion. The plasma ketamine concentration was measured at predetermined intervals and cardiovascular and respiratory parameters recorded at 10 min intervals. Patients were reviewed in recovery and 24 hr postoperatively to assess the adequacy of their recovery and the presence of any undesirable side effects. ~ults: The TCI system had a median performance error against predicted plasma concentrations of 18.9% (SE 2.5%) and a median absolute performance error of 23.3% (SE 2.3%). Divergence was 20.3% (SE 30. I%) and wobble was 12.9% (SE 2. 1%). There was a mean decrease in arterial pressure of 6.4% (SD 19.7%) and a mean increase in heart rate of 4.3 % (SD 17.4%). Little respiratory depression occurred and all patients made a rapid postoperative recovery with none describing unpleasant dreams or hallucinations. Concision: The TCI system provided a clinically acceptable degree of control of the plasma ketamine concentration although some further improvement should be possible by amending the pharmacokinetic model. Clinically the combination with a propofol infusion proved to be a satisfactory anesthetic technique.

Efficacy and Safety of Propofo L v / S Ketamine in Short Surgical/ Diagnostic Procedures in Paediatric Age Group

“…The heart rate changes due to induction and maintenance with propofol in our study were comparable to those of Gray C et al (12) The heart rate changes due to ketamine in our study were comparable to those of Meyer S et al (11) Both propofol and ketamine appear to be associated with acceptable cardiovascular stability but significant difference were noted between them.…”

“…The percentage variation in mean SBP was statistically significant between the groups (p<0.05). The percentage change in mean systolic blood pressure after induction with propofol was comparable to that of Gottschling S et al (13) and Gray C et al (12) Changes in SBP after ketamine infusion in our study were comparable to those of Meyer S et al (11) and Gottschling S et al (13) There was a decrease in mean DBP of 7.4% to 11.4% during the intraoperative period in the propofol group while in ketamine group an increase of 11% to 13% in the DBP was recorded. The percentage variation in mean DBP was statistically significant between the groups (p<0.05).…”

Aufwachverhalten sowie Übelkeit und Erbrechen nach einer totalen intravenösen Anästhesie mit S-(+)-Ketamin-Propofol

“…In der Kombination mit Propofol unterscheidet sich die Inzidenz an unangenehmen Traumerlebnissen nach S-(+)-Ketamin nicht von der Inzidenz nach Alfentanil. Offensichtlich unterdrückt Propofol die psychomimetischen Aufwachreaktionen in ausreichendem Maße; ein Befund, der wiederholt erhoben wurde [14,15,20]. Spontan geäußerter Hauptgrund für die geringere Akzeptanz war die subjektiv als unangenehm empfundene, länger anhaltende Müdigkeit.…”

Anaesthesia for ICU-based procedures: the advantages of and options available for inhalational anaesthesia

“…No apparent threshold concentration could be demonstrated for these effects, and also no concentration at which these effects plateau. Ketamine is often used as the analgesic component of different TIVA techniques with propofol (described by Gray et al, 36 Wieber et al, 37 Roberts et al 38 and Schuttler et al 39 ), and also with midazolam (described by Donner et al 40 ).…”