Efficacy & safety of Propofol Vs Efficacy & safety of Propofol Vs Ketamine in short surgical / Ketamine in short surgical / diagnostic procedures in paediatric diagnostic procedures in paediatric age group age group Presented by Dr. Omprakash Sundrani Dr. Jaya Lalwani (Astt. Prof) Dr. K.K. Sahare (Asso. Prof) Dr. K.P. Dubey (Prof & HOD) Department of Anaesthesiology & Critical care Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital Raipur(C.G.)
Transcript
Efficacy & safety of Propofol Vs Ketamine in Efficacy & safety of Propofol Vs Ketamine in short surgical / diagnostic procedures in short surgical / diagnostic procedures in
paediatric age grouppaediatric age groupPresented by
Dr. Omprakash Sundrani
Dr. Jaya Lalwani (Astt. Prof)Dr. K.K. Sahare (Asso. Prof)
Dr. K.P. Dubey (Prof & HOD)
Department of Anaesthesiology & Critical care Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital
Raipur(C.G.)
INTRODUCTIONINTRODUCTION
Surgery & Anaesthesia both are traumatic experience for a child & cause considerable emotional stress to the child as well as the parents.
Less postop nausea & vomiting (Myles P.S. etal , 1996)
Minimum inhibition of cortisol production(Kenyou CJ etal1985)
No interaction with haem synthesis (Kenyou CJ etal, 1985)
Aims & ObjectivesAims & Objectives
To compare Propofol as a sole anaesthetic agent with Ketamine in paediatric day care surgery in view of
Onset , characteristics of induction & duration of action Effectiveness & quality of sedation Recovery time & Recovery characteristics Effect on cardiovascular & respiratory system Side effects & complications
Material & MethodsMaterial & Methods
Inclusion Criteria 100 patients ASA Grade I & II Either sex 3 to 12 yrs age group Short duration surgeries or
diagnostic procedures
Exclusion Criteria Children below 3 yrs Full stomach Patients suffering from URI Open globe injury, psychiatrics
or patients with seizure disorder Patients allergic to egg & soya Morbid obesity H/O adverse reaction to
anaesthesia & sedation
Material & MethodsMaterial & Methods
Group I :- Inj Propofol 1٪ 2.5 mg/kg + Inj Fentanyl 2µg/kg for induction &
100 - 300µg/kg/min for maintenance
Group II :- Inj Ketamine 2 mg/kg + Inj Midazolam 0.05mg/kg for induction &
30 – 90µg/kg/min for maintenance
Material & MethodsMaterial & Methods
Premedication
I.V. Glycopyrrolate 10µg/kg
I.V. Ranitidine 1-2mg/kg
Material & MethodsMaterial & Methods
Monitoring
HR , BP , SpO2 , RR .
Preoperatively After premedication Immediately after induction At 5min interval for first 30min Every 10min there after upto 2hrs postoperatively
Material & MethodsMaterial & Methods
Patients were observed in postoperative period for signs of complete recovery &
were assessed by fast track eligibility criteria.
Criteria used to determine fast track eligibility after Criteria used to determine fast track eligibility after
ambulatory anaesthesiaambulatory anaesthesia Levels of conciousness : Awake(2) / Arousable with minimal stimulation(1) /
Responsive only to tactile stimulation(0) Physical Activity : Able to move all extremities on command(2) / Some weakness
in movement of all extremities(1) / Unable to voluntarily move the extremities(0) Haemodynamic Stability : Blood pressure <15% of the baseline MAP
value(2) / Blood pressure between 15% and 30% of the baseline MAP value(1) / Blood pressure >30% below the baseline MAP value(0)
Respiratory Stability : Able to breathe deeply(2) / Tachypnea with good cough(1) / Dyspneic with weak cough(0)
Oxygen Saturation Status : Maintain value > 90% on room air(2) / Requires supplemental oxygen (nasal prongs)(1) / Saturation < 90% with supplemental oxygen(0)
Postoperative pain assessment : None or mild discomfort(2) / Moderate to severe pain controlled by i.v. analgesics(1) / Persistent severe pain(0)
Postoperative Emetic Symptoms : None or mild nausea with no active vomiting(2) / Transient vomiting or retching(1) / Persistent moderate to severe nausea and vomiting(0)
Demographic ProfileDemographic Profile
Parameters Group I Group II
No: of patients 50 50
Age Range ( yrs ) 3 - 12 3 – 12
Mean Age ( yrs ) 7.68 ± 2.76 7.66 ± 2.74
Sex distribution ( M/F )
30/20 30/20
Weight Range ( kg ) 10 – 30 10 – 30
Mean Weight ( kg ) 19.74 ± 5.41 19.54 ± 5.17
Induction TimeInduction Time
40.78
42.02
40
40.2
40.4
40.6
40.8
41
41.2
41.4
41.6
41.8
42
42.2
I II
Group
Dose Requirement for InductionDose Requirement for Induction
2.48
49
2.2
42.4
0
5
10
15
20
25
30
35
40
45
50
I II
GROUP
INDUCTION DOSE (mg/ kg) TOTAL INDUCTION DOSE (mg)
Dose Requirement for Dose Requirement for MaintenanceMaintenance
226.14
79.16
218.9
70.9
241.8
118.3
0
50
100
150
200
250
Me
an
Infusion rate (µg/ kg/ min) Total maintenance dose (mg) Total dose (mg)
Gr oup I Gr oup I I
Supplementation of Drug for Supplementation of Drug for maintenancemaintenance
28
22
0
5
10
15
20
25
30
I II
GROUP
Distribution according to duration Distribution according to duration of Anaesthesiaof Anaesthesia
20
34
12
22
6 6
22
36
10
24
4 4
0
5
10
15
20
25
30
35
40
25-35 36-45 46-55 56-65 66-75 >75
TIME (min)
Pa
tie
nts
(%
)
Group I Group II
Distribution according to duration Distribution according to duration of surgeryof surgery
22
34
20
1210
2
22
32
24
16
42
0
5
10
15
20
25
30
35
40
15-25 26-35 36-45 46-55 56-65 >65
Time (min)
Pa
tie
nts
(%
)
Group I Group II
T
Mean Heart rate at various time Mean Heart rate at various time intervalinterval
90
95
100
105
110
115
120
Pre
oper
ativ
e
Afte
r pre
med
icat
ion
Afte
rin
duct
ion
10 m
inut
esaf
ter
20 m
inut
esaf
ter
30 m
inut
esaf
ter
40 m
inut
esaf
ter
50 m
inut
esaf
ter
60 m
inut
esaf
ter
70 m
inut
esaf
ter
80 m
inut
esaf
ter
90 m
inut
esaf
ter
Pos
top
erat
ive
ME
AN
(BP
M)
Group I Group II
Mean Systolic arterial pressure at Mean Systolic arterial pressure at various time intervalsvarious time intervals
0
20
40
60
80
100
120
140
Pre
oper
ativ
e
Afte
r pre
med
icat
ion
Afte
rin
duct
ion
10 m
inaf
ter
20 m
inaf
ter
30 m
inaf
ter
40 m
inaf
ter
50 m
inaf
ter
60 m
inaf
ter
70 m
inaf
ter
80 m
inaf
ter
90 m
inaf
ter
Pos
top
erat
ive
ME
AN
(mm
Hg)
Group I Group II
Mean Diastolic arterial pressure Mean Diastolic arterial pressure at various time intervalat various time interval
0102030405060708090
Pre
oper
ativ
e
Afte
r pre
med
icat
ion
Afte
rin
duct
ion
10 m
inaf
ter
indu
ctio
n20
min
afte
rin
duct
ion
30 m
inaf
ter
indu
ctio
n40
min
afte
rin
duct
ion
50 m
inaf
ter
indu
ctio
n60
min
afte
rin
duct
ion
70 m
inaf
ter
indu
ctio
n80
min
afte
rin
duct
ion
90 m
inaf
ter
indu
ctio
nPo
stop
erat
ive
ME
AN
(mm
Hg)
Group I Group II
Mean Respiratory rate at various Mean Respiratory rate at various time intervaltime interval
0
5
10
15
20
25
Pre
ope
rativ
e
Afte
rpr
emed
icat
ion
Afte
rin
duct
ion
10 m
min
afte
rin
duct
ion
20 m
min
afte
rin
duct
ion
30 m
min
afte
rin
duct
ion
40 m
min
afte
rin
duct
ion
50 m
min
afte
rin
duct
ion
60 m
min
afte
rin
duct
ion
70 m
min
afte
rin
duct
ion
80 m
min
afte
rin
duct
ion
90 m
min
afte
rin
duct
ion
Pos
t ope
rativ
e
Mea
n R
R
Group I
Group II
Incidence of perioperative Incidence of perioperative complicationscomplications
14
2428
2 0 8 4010
810
26
1216
05
101520
2530
Pain
on
inje
ctio
n/Th
rom
boph
lebi
tis
Spon
tane
ous
mov
emen
ts
Apno
ea
Lary
ngos
pasm
/Br
onch
ospa
sm
Nys
tagm
us
Emer
genc
e ph
enom
enon
Nau
sea
/ Vom
iting
PER
CEN
TAG
E
Group I
Group II
Fast Track Eligibility Criteria at Fast Track Eligibility Criteria at various time intervalvarious time interval
92
28
96
46
100
80
0
10
20
30
40
50
60
70
80
90
100
Pa
tie
nts
(%
)
Up to 30min Up to 60min Up to 120 min
Time
Gr oup I Gr oup I I
Quality of AnaesthesiaQuality of Anaesthesia
80
40
20
50
0
10
0
20
40
60
80
Pat
ient
s(%
)
Excellent Good Poor
Group I Group II
SummarySummary There was no significant difference in induction dose &
induction time b/w the two groups Infusion rate for maintenance of anaesthesia is more in
propofol group Arterial B.P. decreased in Propofol group & increase was
seen in Ketamine group Increase in Heart rate is less with Propofol Incidence of Apnoea is more with Propofol Pain on injection was seen only with Propofol Incidence of Spontaneous movement was more in Propofol
group Laryngospasm / Bronchospasm was more in Ketamine
group
ConclusionConclusion
Propofol provides smooth Induction with rapid and smooth recovery
