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Revista Cubana de Anestesiología y Reanimación

2022, Number 3

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Revista Cubana de Anestesiología y Reanimación 2022; 21 (3)

Tow concentrations of ketofol in total intravenous anesthesia for minimally invasive surgery

Labrada DA, Rivera MY, Costa OG

Language: Spanish
References: 30
Page: 1-14
PDF size: 500.04 Kb.


ABSTRACT

Introduction: In recent years, a special interest has appeared in the ketamine/propofol combination for patients intervened by minimally invasive procedures.
Objective: To evaluate the effectiveness and safety of total intravenous anesthesia with ketofol at 1:4 concentration versus 1:2 concentration in patients undergoing minimally invasive surgery.
Methods: An analytical, quasiexperimental, prospective and longitudinal study was carried out at General Calixto García University Hospital, between December 2019 and December 2020, with thirty patients divided into two groups of fifteen patients each: study group (SG; ketofol 1:4) and control group (CG; ketofol 1:2). The following aspects were analyzed: mean blood pressure and intraoperative cardiac frequency, degree of hypnosis, degree of nociception, necessity of rescue for hypnosis and analgesia, anesthetic recovery time, postoperative analgesia and adverse effects.
Results: Age, sex, weight, physical condition and type of surgery were similar between groups. Heart rate showed no differences between groups. Mean blood pressure after incision was higher in the control group, with significant differences (P=0.03). The necessity of intraoperative rescue for hypnosis and analgesia was significantly higher in the control group. Regarding anesthetic recovery, postoperative analgesia and adverse effects, there were no significant differences.
Conclusion: The ketofol combination was safe and effective for providing adequate anesthesia in minimally invasive surgical procedures with surgical times of less than thirty minutes. The 1:4 concentration provided better hemodynamic stability, adequate hypnosis and intraoperative analgesia, with lower incidence of adverse effects.


REFERENCES

  1. Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246-58. DOI: https://doi.org/10.1213/ANE.00000000000036681.

  2. Bhardwaj A, Panda N, Chauhan R, Bloria SD, Bharti N, Bhagat H, et al2. . Comparison of Ketofol (Combination of Ketamine and Propofol) and Propofol Anesthesia in Aneurysmal Clipping Surgery: A Prospective Randomized Control Trial. Asian J Neurosurg. 2020;15(3):608-13. DOI: https://doi.org/10.4103/ajns.AJNS_346_192.

  3. Khandelwal A, Chaturvedi A, Sokhal N, Singh A, Sharma HB. Comparison of propofol and ketofol on transcranial motor evoked potentials in patients undergoing thoracolumbar spine surgery. Asian Spine J. 2021. DOI: https://doi.org/10.31616/asj.2020.05623. .

  4. Woldekidan NA, Mohammed AS. Clinical knowledge and practice of “Ketofol” at University of Gondar Comprehensive Specialized Hopsital. Front Med (Laussane). 2021;8. DOI: http://doi.org/10.3389/fmed.2021.5559734.

  5. Ahmed S, Aweke Z, Jemal B. Evidence based guideline on use of ketofol (Ketamine and Propofol admixture) for procedural sedation and analgesia (PSA) in pediatrics surgery: Review article. International Journal of Surgery Open. 2020;25:52-8. DOI: https://doi.org/10.1016/j.ijso.2020.06.0085.

  6. Miner J. Ketamine or Ketofol: Do we have enough evidence to know which one to use? Acad Emerg Med. 2017;24(12):1511-3. DOI: http://doi.org/10.1111/acem.13276.

  7. Walravens S, Buylaert W, Steen E, De Paepe P. Implementation of protocol using ketamine-propofol (“ketofol”) in a 1 to 4 ratio for procedural sedation in adults at a university hospital emergency department - report on safety and effectiveness. Acta Clin Belg. 2021;76(5):359-64. DOI: https://doi.org/10.1080/17843286.2020.17412287.

  8. Ghojazadeh M, Sanaie S, Pouya S, Faghih SS, Soleimanpour H. Using Ketamine and Propofol procedural sedation of adults in the emergency department: A systematic review and meta-analysis. Adv Pharm Bull. 2019;9(1):5-11. DOI: http://doi.org/10.15171/apb.2019.0028.

  9. Nevešćanin Biliškov A, Gulam D, Žaja M, Pogorelić Z. Total Intravenous Anesthesia with Ketofol versus Combination of Ketofol and Lidocaine for Short-Term Anesthesia in Pediatric Patients; Double Blind, Randomized Clinical Trial of Effects on Recovery. Children. 2022;9:282. DOI: https://doi.org/10.3390/children9020282

  10. . Acosta Sánchez M, Labrada Despaigne A, Otero Sierra M. Cirugía de mínimo acceso: Un cambio de paradigma. Aportes del Hospital Universitario “General Calixto García”. Arch Hosp Calixto García 2019 [acceso: 05/02/2020];7(1):114-23. Disponible en: Disponible en: http://www.revcalixto.sld.cu/index.php/ahcg/article/view/310 10.

  11. Barends CRM, Absalom AR, Struys MM. Drug selection for ambulatory procedural sedation. Anesth Pain Med. 2021;11(2). DOI: https://doi.org/10.5812/aapm.11391911. .

  12. Sabertanha A, Shakhsemampour , Ekrami M, Allahyari E. Comparison of infusion of propofol and ketamine-propofol mixture (ketofol) as anesthetic maintenance agents on blood pressure of patiens undergoing orthopedic leg surgery. Anesth Pain Med. 2019;9(6). DOI: https://doi.org/10.5812/aapm.9699812.

  13. Aboeldahab H, Samir R, Hosny H, Omar A. A comparative study between propofol, ketamine and their combination (Ketofol) as an induction agent. Egyptian Journal of Anaesthesia. 2011;27(3):145-50. DOI: https://doi.org/10.1016/j.egja2011.04.00713.

  14. Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005;26(5):553-7 DOI: https://doi.org/10.1007/s00246-004-0707-414.

  15. Weatherall A, Venclovas R. Experience with a propofol-ketamine mixture for sedation during pediatric orthopedic surgery. Paediatr Anaesth. 2010;20(11):1009-16. DOI: https://doi.org/10.1111/j.1460-9592.2010.03420.x15.

  16. Phillips W, Anderson A, Rosengreen M, Johnson J, Halpin J. Propofol versus propofol/ketamine for brief painful procedures in the emergency department: clinical and bispectral index scale comparison. J Pain Palliat Care Pharmacother. 2010;24(4):349-55. DOI: https://doi.org/10.3109/15360288.2010.50650316.

  17. Lucas da Silva PS, De Aguiar VE, Reis Waisberg D, Augusto Passos RM, Flor Park MV. The use of Ketofol for procedural sedation and analgesia in children with hematological diseases. Pediatr Int. 2011;53(1):62-7. DOI: https://doi.org/10.1111/j.1442-200X.2010.03200.x17.

  18. Greer A, Treston G. Factors associated with patient-reported procedural memory following emergency department procedural sedation with ketamine and propofol: A prospective cohort of 563 patients. Emerg Med Australas. 2018;30(2):200-8. DOI: https://doi.org/10.1111/1742-6723.1288418.

  19. Vázquez Barreto M, Rivera Ordoñez A, Salvador Martínez R. Inducción anestésica con ketofol para el paciente quemado. Rev Mex Anestesiol. 2016 [acceso: 12/05/2020];39(4):274-7. Disponible en: Disponible en: http://www.medigraphic.com/pdfs/rma/cma-2016/cma164d.pdf 19.

  20. Bhaire VS, Panda N, Luthra A, Chauhan R, Rajappa D, Bhagat H. Effect of Combination of Ketamine and Propofol (Ketofol) on Cerebral Oxygenation in Neurosurgical Patients: A Randomized Double‑Blinded Controlled Trial. Anesth Essays Res. 2019;13(4):643-8. DOI: https://doi.org/10.4103/aer.AER_119_1920.

  21. Mohammad A, Makram J, Labib M, Gaber S. Reliable and rapid smooth extubation after “ketamine-propofol mixture” for induction of general anesthesia in laparoscopic drilling of polycystic ovary: A randomized, doublé-blind, comparative study. Anesth Pain Med. 2022;11(2). DOI: https://doi.org/10.5812/aapm.11391921.

  22. Gorlin AW, Rosenfeld DM, Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia. J Anaesthesiol Clin Pharmacol. 2016; 32(2):160-7. DOI: https://doi.org/10.4103/0970-9185.18208522.

  23. Daabis M, Elsherbiny M. Alotibi R . Assessment of diferent concentration of Ketofol in procedural operation. BJMP. 2009 [acceso: 15/01/2020];2(1):27-31. Disponible en: Disponible en: http://www.bjmp.org/content/assessment-different-concentrationKetofolprocedural-operation 23.

  24. Arcia Hernández RE. Eficacia, seguridad y efectos adversos en la utilización de Ketofol en concentración de 2:1 y 3:1, en pacientes adultos sometidos a procedimientos menores a 30 minutos en el Hospital Centro Médico Militar, en el período de abril 2016 a agosto 2017 [Tesis de Grado]. Universidad Mariano Gálvez de Guatemala. 2018 [acceso: 05/05/2020]. Disponible en: Disponible en: https://glifos.umg.edu.gt/digital/48140.pdf 24.

  25. Cajina Dávila M, López García V. Anestesia endovenosa total con ketofol en dos concentraciones diferentes en pacientes adultos sometidos a Colecistectomía Laparoscópica el Hospital escuela Antonio Lenin Fonseca en el período Noviembre-Enero de 2017 [Tesis de Grado]. Universidad Nacional Autonóma de Nicaragua]. 2017 [acceso: 05/05/2020]. Disponible en: Disponible en: https://repositorio.unan.edu.ni/3975/ 25.

  26. Kurdi M. Deva R . A comparison of two different proportions of Ketofol with fentanyl-Propofol for sedoanalgesia for tubal sterilization by minilaparotomy: A randomized doublé blind trial. J Obstetric Anaesth Crit Care. 2015 [acceso: 05/03/2020];5:84-9. Disponible en: Disponible en: http://www.joacc.com/article.asp?issn=22494472;year=2015;volume=5;issue=2;spage=84;epage=89;aulast=Kurdif966977db1cd92 26.

  27. Jalili S, Esmaeeili A, Kamali K, VR. Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy. Afri Health Sci. 2019;19(1):1736-44. DOI: https://dx.doi.org/10.4314/ahs.v19i1.5027.

  28. Coulter FLS, Hannam JA, Anderson BJ. Ketofol dosing simulations for procedural sedation. Pediatric Emergency Care. 2014;30(9):621-30. DOI: https://doi.org/10.1097/PEC.000000000000022228.

  29. Smischney NJ, Seisa MO, Morrow AS, Ponce OJ, Wang Z, Alzuabi M, Heise KJ, Murad MH. Effect of Ketamine/Propofol Admixture on Peri-Induction Hemodynamics: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract. 2020 [acceso: 17/01/2021]; 2020:9637412. Disponible en: Disponible en: https://www.hindawi.com/journals/arp/2020/9637412/ 29.

  30. Sherry N, Riz k, Enas M, Samir. Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy. Egyptian Journal of Anaesthesia. 2014 [acceso: 12/05/2020];30(1):13-9. Disponible en: https://www.tandfonline.com/doi/full/10.1016/j.egja.2013.09.00330. . Sherry N, Riz k, Enas M, Samir. Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy. Egyptian Journal of Anaesthesia. 2014 [acceso: 12/05/2020];30(1):13-9. Disponible en: https://www.tandfonline.com/doi/full/10.1016/j.egja.2013.09.00330.




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