Effects of ketofol and propofol on intubation conditions and hemodynamics without the use of neuromuscular blockers in patients undergoing tympanomastoidectomy

The effect of ketofol, a mixture of ketamine and propofol in various ratios, on hemodynamic, for intubation without the use of neuromuscular blockers, has not been elucidated in patients undergoing tympanomastoidectomy. We evaluated the effects of ketofol and propofol on intubation conditions and hemodynamic without the use of a neuromuscular blocker. The prospective randomized, double-blinded study was scheduled for tympanoplasty or mastoidectomy. The patients were divided randomly into a propofol group (Group P) and a ketofol group (Group KP). Intubation conditions, changes in hemodynamics, HR, MAP, systolic arterial pressure (SAP), and SpO2 values were recorded before induction, after induction, after intubation, and at 3-min intervals during the first 30 min, 5-min intervals for the next 30 min, and 10-min intervals after that. In the intragroup evaluation, SAP, DAP, MAP and HR values were lower in both groups compared to the baseline values. Hemodynamic values were significantly lower in Group P than in Group KP after intubation compared to baseline. DAP at 12 and 18 min, DAP and MAP at 24 min, SAP, DAP and MAP at 27 min, and SAP and MAP at 30 min after the start of the operation were significantly lower in Group P than in Group KP. The need for ephedrine and the number of patients who required ephedrine were significantly lower in Group KP than in Group P. Ketofol provided appropriate intubation conditions similar to propofol, without the use of a neuromuscular blocker, and contributed to better hemodynamic conditions in patients undergoing tympanomastoidectomy.

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Stevens JB, Wheatley L. Tracheal ıntubation in ambulatory surgery patients: using remifentanil and propofolcase report. AANA J. 2008;76:41-5.

Gulhas N, Topal S, Erdogan Kayhan G, et al. Remifentanil without muscle relaxants for intubation inmicrolaryngoscopy: a double blind randomised clinical trial. Eur Rev MedPharmacol Sci. 2013;17:1967-73.

Durmus M, Ender G, Kadir AB, et al. Remifentanil with thiopental for tracheal ıntubation without muscle relaxants. Anesth Analg. 2003;96:1336.

Jalili M, Bahreini M, Doosti-Irani A, et al. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med. 2016;34:558-69.

Fabbri LP, Nucera M, Marsili M, et al. Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: Is ketamine not only a “rescue drug”? .Med Sci Monit. 2012;18:57580.

Ko SH, Kim DC, Han YJ, et al. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg. 1998;86:658-61.

Akaslan F, Özcan AT, Canlı Ş, ve ark. Çocuklarda kas gevşeticisiz trakeal entübasyon. Ege J of Med. 2016;55:14-9.

Jabbour-Khoury SI, Dabbous AS, Rizk LB, et al. A combination of alfentanillidocaine-propofol provides better intubating conditions than fentanyllidocaine-propofol in the absence of muscle relaxants. Canadian J Anesthesia. 2003;50:116-20.

Gupta A, Kaur R, Malhotra R, et al. Comparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants. Pediatr Anaesth. 2006;16:399-405.

Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand. 2000;44:465–9.

Morgan GE, Mikhail MS, Murray MJ, editors. İntravenöz Anestezikler. In: Clinical Anesthesiology 5 th ed. International Edition: Lange Medical Books. 2015;175-88.

Erdogan MA, Begec Z, Aydogan MS, et al. Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial. J Anesth. 2013;27:12-7.

Alexander R, Olufolabi AJ, Booth J, et al. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia.1999;54:1037-40.

Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Brit J Anaesthesia. 2005;94:150-8.

St Pierre M, Kessebohm K, Schmid M, et al. Recovery from anaesthesia and incidence and intensity of postoperative nausea and vomiting following a total intravenous anaesthesia (TIVA) with S-(+)-ketamine/propofol compared to alfentanil/propofol. Anaesthesist. 2002;51:973-9.

Liu YH, Li MJ, Wang PC, et al. Use of Dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery. Laryngoscope. 2001;111:1271-4.

Eidi M, Kolahdouzan K, Hosseinzadeh H, et al. A comparison of preoperative ondansetron and dexamethasone in the prevention of post-tympanoplasty nausea and vomiting. Iran J Med Sci. 2012;37:166-72.

Donlon Jr. JV. Anesthesia for Eye, Ear, Nose, and Throat Surgery. In: Miller RD(ed). Anesthesia. Fifth edition. New York: Churchill Livingstone; 2000, 2173-98.

White PF, Freire AR. Günübirlik Anestezi. In: Miller RD Edition. Anesthesia. 6th editors Philadelphia- Pennsylvania Churchill Livingstone. 2010:2589635.

Watcha MF, White PF. Postoperative nause and vomiting. Its etiology treatment and prevention. Anesthesiology. 1992;77:162-84.
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  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )