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Category: Volume 08 Issue 11 November 2020
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Title: Comparison of low dose ketamine and butorphanol as an adjuvant to propofol for induction in patients undergoing laparoscopic cholecystectomy: A randomized clinical study

Authors: Rampal Singh, Sarfraz Ahmad, Ankur Garg, Pragati Saxena, Malti Agrawal, Gopal Krishan, Ekta Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.20

Abstract

Introduction: General anaesthesia is associated with marked cardiovascular changes. Induction with propofol is accompanied by decrease in mean blood pressure and heart rate. Ketamine and butorphenol provides stable perioperative hemodynamics during general anaesthesia.

Aims and Objectives: The aim of this study was to evaluate the efficacy of intravenous low dose ketamine with intravenous butorphanol on hemodynamic stability during laryngoscopy and intubation, intraoperative hemodynamics and postoperative pain.

Methods and Materials: It was a prospective randomised clinical study in which 100 ASA grade 1 or 2 patients who were posted for elective laparoscopic cholecystectomy under general anaesthesia, were enrolled into one of the two groups according to the agents to be given as an adjuvent for induction of general anaesthesia. Group A patients received 0.3mg/kg ketamine and group B patients received butorphanol 0.02mg/kg by intravenous route.

Conclusion: The present study observed excellent endotracheal intubation conditions with propofol and ketamine combination as compared to propofol and butorphanol combination. Analgesic effects of ketamine and butorphanol in the postoperative period were similar and helped painless shifting of patients.

Keywords: Butorphanol, Hemodynamic response, Endotracheal intubation, Ketamine, Laparoscopic cholecystectomy.

References

  1. Adams HA. S-(+)-ketamine. Circulatory interactions during total intravenous anaesthesia and analgesia-sedation. Der Anaesthesist. 1997 Dec;46(12):1081-7.
  2. Weinbroum AA. A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain. Anaesthesia& Analgesia. 2003 Mar 1;96(3):789-95.
  3. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Canadian Journal of Anaesthesia/Journal canadiend' anesthésie. 2011 Oct 1;58(10):911-23.
  4. Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2005 Jan 1;102(1):211-20.
  5. Abbasivash R, Aghdashi MM, Sinaei B, Kheradmand F. The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response. J Clin Anesth 2014; 26: 628-33.
  6. Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anaesthesia: Propofol–ketamine and propofol–fentanyl. Saudi journal of anaesthesia. 2010 May;4(2):72-9.
  7. Basagan-Mogo E, Goren S, Korfali G, Turker G, Kaya FN. Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine. Clinics. 2010;65(2):133-8.
  8. Yang HS, Song BG, Kim JY, Kim SN, Kim TY. Impact of propofol anesthesia induction on cardiac function in low-risk patients as measured by intraoperative Doppler tissue imaging. J Am Soc Echocardiogr 2013; 26:727-35.
  9. Aasim SA, Syamasundara Rao B, Zubair SI. Comparison of Quality of Anaesthesia with Propofol Fentanyl and Propofol Ketamine as Total Intravenous Anaesthesia Technique for Short Surgical Procedures. Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol. 2014 Jul;8(2):105-7.
  10. Baradari AG, Firouzian A, Kiasari AZ, Aarabi M, Emadi SA, Davanlou A, Motamed N, Abdolmaleki EY. Effect of etomidate versus combination of propofol-ketamine and thiopental-ketamine on hemodynamic response to laryngoscopy and intubation: a randomized double blind clinical trial. Anesthesiology and pain medicine. 2016 Feb;6(1).
  11. Kulkarni KR, Dalal NR. Comparative Study Between Ketamine–Propofol And Butorphanol-Propofol for Ease of Laryngeal Mask Airway Insertion in Short Surgical Procedures. Int J Anesthesiol Res. 2014 Nov 10;2:70-5.
  12. Saxena D, Dixit A, Kumar N, Arya B, Sanwatsarkar S, Bhandari S. Efficacy of low-dose ketamine as sole analgesic agent in maintaining analgesia and intraoperative hemodynamics during laparoscopic gynecological surgeries. Anaesthesia, Essays and Researches. 2017 Apr;11(2):385-9.
  13. Rekhi BK, Grewal TK, Kumar P, Kaur S, Mehta P. comparative study of fentanyl, butorphanol and nalbuphine in attenuation of haemodynamic responses in laparoscopic cholecystectomy. Journal of Evolution of Medical and Dental Sciences. 2018 Apr 23;7(17):2156-63.
  14. Firoozabadi MD, Ebadi A. The Effect of Ketamine-Thiopental Combination on Hemodynamic Changes by Laryngoscopy and Endotracheal Intubation in Cesarean Section under General Anaesthesia. Switzerland Res Park J. 2014;103(1):192-8
  15. Rajan S, Hassain A, Puthenveettil N, Kumar L. Efficacy and safety of low-dose ketamine as an adjunct analgesic and amnesic during caesarean section under general anaesthesia. Indian journal of anaesthesia. 2015 Oct;59(10):653-57.
  16. Honarmand A, Safavi M. Cardiovascular response during induction of anesthesia and tracheal intubation with thiopental added to fentanyl, ketamine, and fentanyl-ketamine. Ghana medical journal. 2009 Mar;43(1):7-12.
  17. Philip BK, Scott DA, Freiberger D, Gibbs RR, Hunt C, Murray E. Butorphanol compared with fentanyl in general anaesthesia for ambulatory laparoscopy. Canadian journal of anaesthesia. 1991 Mar 1;38(2):183-6.
  18. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Canadian Journal of Anesthesia/Journal canadiend'anesthésie. 2011 Oct 1;58(10):911-23.
  19. Singh H, Kundra S, Singh RM, Grewal A, Kaul TK, Sood D. Preemptive analgesia with ketamine for laparoscopic cholecystectomy. Journal of anaesthesiology, clinical pharmacology. 2013 Oct;29(4):478-84.
  20. Weilin Z, Xuegang Z, Xiaojian J. Preventive Analgesic Effect of Preoperative Ketamine in Relieving Postoperative Pain after Laparoscopic Cholecystectomy. Chinese Journal of Minimally Invasive Surgery. 2007(8):36-9
  21. Ye F, Wu Y, Zhou C. Effect of intravenous ketamine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: a meta-analysis. Medicine. 2017 Dec;96(51).
  22. Schwesinger WH, Reynolds JC, Harshaw DH, Frakes LA. Transnasalbutorphanol and intramuscular meperidine in the treatment of postoperative pain. Advances in Therapy. 1992 Jan 1;9(3):123-9.
  23. Darabi ME, Mireskandari SM, Sadeghi M, Salamati P, Rahimi E. Ketamine has no pre-emptive analgesic effect in children undergoing inguinal hernia repair. Actamedicairanica. 2008 Dec 1:46(6): 451-6.
  24. Dullenkopf A, Müller R, Dillmann F, Wiedemeier P, Hegi TR, Gautschi S. An intraoperative pre-incision single dose of intravenous ketamine does not have an effect on postoperative analgesic requirements under clinical conditions. Anaesthesia and intensive care. 2009 Sep;37(5):753-7.

Corresponding Author

Gopal Krishan

Associate Professor, Department of Anaesthesiology, RMCH Bareilly