Title: Haemodynamic Effects during Induction in Cervical Spine Injuries Patients: Comparison of Three Drug Dose Combinations of Ketamine and Propofol
Authors: Dr Ravinder Dhanerwa, Dr H. K.Mahajan, Dr Parshuram Chauhan
DOI: http://dx.doi.org/10.18535/jmscr/v4i1.04
Background and Aims: Cervical spine injured patients have bradycardia & hypotension, which may be aggravated during induction of anaesthesia. Very few studies are available regarding this problem. Studies are available where propofol and ketamine or propofol and ephedrine are used to maintain cardiovascular stability but these too are limited to normal population. We decided to compare the haemodynamic parameters during induction with three different drug dose combinations of propofol and ketamine to know the best drug dose combination of these two drugs for haemodynamic stability in cervical spine injury patients. Methods: We studied 60 adult patients of either sex with established cervical spine injury with quadriplegia scheduled to undergo elective surgical procedures under general anesthesia and randomly divided into 3 groups. Data was collected by measuring Pulse rate, Systolic Blood Pressure, Diastolic Blood Pressure & Mean Blood Pressure. The results: Haemodynamic changes in group PK (propofol 1.0 mg/kg + ketamine 1.0 mg/kg) were less than the group PPK (propofol 1.5 mg/kg + ketamine 0.5 mg/kg) but more as compared to PKK (propofol 0.5 mg/kg + ketamine 1.5 mg/kg). Conclusion: To avoid haemodynamic changes during induction of anesthesia in cervical spine injury patients, drug dose combination of PKK (propofol 0.5 mg/kg + ketamine 1.5 mg/kg) should be preferred over PPK (propofol 1.5 mg/kg + ketamine 0.5 mg/kg). Keywords: Cervical Spine Injury, Haemodynamic stability, Induction of Anaesthesia, Ketamine, Propofol. 1. P. R. Hambly& B. Martin. Anaesthesia for chronic spinal cord lesions. Anaesthesia 1998; 53: 273-289. 2. Colachis SC. Autonomic hyperreflexia with spinal cord injury. Journal of the American Paraplegia Society 1992; 15: 171-186. 3. Schonwald G, Fish KJ, Perkash I. Cardiovascular complications during anesthesia in chronic spinal cord injured patients. Anesthesiology 1981; 55: 550-558. 4. Goy J. Spinal injuries. In : Loach A, ed. Orthopaedic Anaesthesia. Edward Arnold: London, 1994; 145-157. 5. John DA, Tobey RE, Homer LD, Rice CL. Onset of succinylcholine induced hyperkalemia following denervation. Anesthesiology 1976; 45: 294-299. 6. Ozakocak I, Altunkaya H. Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction. European Journal of Anaesthesiology 2005; 22: 44-48. 7. Furuya A, Matsukawa T, Ozaki M. Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol. European Journal of Anaesthesiology 2001; 18: 88-92. 8. Price ML, Millar B, Grounds M, Cashman J. Changes in cardiac index and estimated systemic vascular resistance during induction of anaesthesia with thiopentone, methohexitone, propofol and etomidate. BritishJournalofAnaesthesia 1992; 69: 172-176. 9. Fairfield JE, Dritsas A, Beale RJ. Haemodynamic effects of propofol: induction with 2.5 mg/kg. British Journal of Anaesthesia 1991; 67: 618-620. 10. Lindgren L, Randell T. Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation: comparison between propofol and thiopentone. BritishJournalofAnaesthesia 1993; 70: 306-310. 11. Thomas J, Michael M, David G. Sympathetic response to induction of anesthesia in humans with propofol or ketamine. Anaesthesiology1992; 76: 725-733. 12. Hui TW, Short TG, Hong W, Suen T. Additive interactions between propofol and ketamine when used for anesthesia induction in female patients. Anesthesiology 1995; 82: 641-648.Abstract
References