Document Detail


Addition of low-dose ketamine to propofol-fentanyl sedation for gynecologic diagnostic laparoscopy: randomized controlled trial.
MedLine Citation:
PMID:  20417423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To assess the feasibility of propofol-fentanyl sedation protocol with ketamine for gynecologic diagnostic laparoscopy. DESIGN: Prospective, double-blind, randomized study (Canadian Task Force classification I). SETTING: Outpatient operating unit in a university hospital specializing in obstetrics and gynecology. PATIENTS: Eighty women who underwent outpatient gynecologic diagnostic laparoscopy. INTERVENTIONS: Patients were randomly assigned to receive fentanyl, 1 microg/kg, and normal saline solution (group F, n = 40), or fentanyl, 1 microg/kg, and ketamine, 0.5 mg/kg (group FK, n =40), followed by propofol, 2.0 mg/kg, for sedation induction. During surgery, propofol was supplemented to achieve a target Ramsey score of 6, and cardiopulmonary support was required to maintain stable vital signs. MEASUREMENTS AND MAIN RESULTS: Five of 40 patients (12.5%) in group FK reported pain associated with propofol injection compared with 33 of 40 patients (82.5%) in group F. During surgery, 7 patients (17.5%) in group FK required rescue propofol compared with 32 patients (80.0%) in group F (p <.001). The mean (SD) rescue dose of propofol was 0.4 (0.5) mg/kg in group FK compared with 1.6 (0.6) mg/kg in group F (p <.001). In group F, 17 patients (42.5%) required assisted mask ventilation because of respiratory depression, and in 21 patients (52.5%), atropine therapy was necessary to treat bradycardia, compared with 6 patients (15.0%) and 11 patients (27.5%), respectively, in group FK (p <.05). The mean arterial blood pressure at the end of induction, pneumoperitoneum inflation, and trocar insertion was significantly decreased in group F compared with group FK (p <.05). No differences were observed between the 2 groups insofar as operation duration, recovery time, discharge time, intraoperative awareness, incidence of postoperative nausea and vomiting, and postoperative pain. Although patient satisfaction scores were comparable, a higher degree of gynecologist satisfaction was observed in group FK compared with group F (p <.001). CONCLUSION: Addition of low-dose ketamine to propofol-fentanyl sedation can provide more stable and satisfactory operation conditions in gynecologic diagnostic laparoscopy.
Authors:
Yu-Ying Tang; Xue-Mei Lin; Wei Huang; Xiao-Qing Jiang
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  17     ISSN:  1553-4650     ISO Abbreviation:  J Minim Invasive Gynecol     Publication Date:    2010 May-Jun
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-06-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  325-30     Citation Subset:  IM    
Copyright Information:
Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, China. yutingtang@sohu.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Intravenous
Anesthetics, Intravenous / administration & dosage
Double-Blind Method
Drug Therapy, Combination
Female
Fentanyl / administration & dosage*
Humans
Hypnotics and Sedatives / administration & dosage
Ketamine / administration & dosage*
Laparoscopy*
Patient Satisfaction
Propofol / administration & dosage*
Prospective Studies
Vital Signs
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Hypnotics and Sedatives; 2078-54-8/Propofol; 437-38-7/Fentanyl; 6740-88-1/Ketamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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