#35918 A randomized control trial to evaluate the effects of Ketofol versus propofol on cerebral oxygenation in patients undergoing Trans-sphenoidal pituitary surgery under total intravenous anesthesia

Abstract

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Background and Aims

Propofol causes hypotension and respiratory depression while Ketamine preserves airway reflexes and respiration, prevents hypotension. Ketofol (combination of Propofol and Ketamine) has shown to have cumulative effects on analgesia, and hypnosis,requiring lower dose of drug and less adverse effects ,maintains hemodynamics. Effect of various intravenous anaesthetic agents on cerebral oxygenation has not been evaluated. We compared the effects of Ketofol&Propofol on cerebral oxygenation in patients undergoing pituitary surgery.

Methods

Study ,conducted on 50 patients,undergoing pituitary surgery.Patients divided into Ketofol&Propofol groups,25 patients each. Intra-operative cerebral oxygenation (rSO2), hemodynamic parameters ,SpO2, Total analgesic,time to emergence and time to first post-operative analgesia ,recorded.

Results

In both groups, baseline values of rSO2 were within normal limits. rSO2 values were significantly higher in Ketofol-group than Propofol-group all- time, on both sides. rSO2 during surgery were higher in Ketofol-group and lower in Propofol-group on both sides . rSO2 values at specific stages of surgery/anaesthesia were higher than baseline in Ketofol-group and lower in Propofol-group on both side, .Intraoperative hemodynamic parameters was similar in the two groups, but significant increase in HR and MAP in Propofol group was observed during various stimuli (anaesthesia/surgical) compared to Ketofol. Episodes of hypotension were significantly higher in Propofol compared to Ketofol group Intraoperative requirement of opioid , propofol was significantly reduced in Ketofol-group .Time to first analgesic was longer in Ketofol than Propofol-group, emergence from anaesthesia was significantly longer in Propofol group.

Conclusions

In patients with pituitary surgery, Ketofol provides better cerebral oxygenation, hemodynamic stability , rapid emergence , prolong analgesia, compared to Propofol.

Attachment

Sudeshna , ethics.pdf