Comparison of the Effects of Ketamine-Remifentanil with Ketamine-Propofol on Pain, Agitation and Hemodynamic Changes during Closed Reduction of Nasal Fracture

Abstract

Background and Aim: Choosing an appropriate anesthetic agent for induction and maintenance of anesthesia is very important in hemodynamic stability and pain control. The aim of this study was to compare the effects of ketamine-remifentanil combination with ketamine-propofol combination on pain, agitation and hemodynamic changes during closed reduction of nasal fracture. Material and Methods: This single-blind clinical trial included 80 patients between 16 and 18 years of age with ASA1 physical status who had undergone closed reduction for nasal fracture. Patients in the group 1 received 0.75 mg/kg ketamine and 2µ/kg remifentanil and group 2 received 0.75 mg/kg ketamine and 1.5 mg/kg propofol to induce anesthesia. Hemodynamic changes (heart rate, systolic and diastolic blood pressure), pain intensity, agitation, as well as nausea and vomiting and changes in arterial hemoglobin oxygen saturation during surgery were evaluated immediately after induction of anesthesia and after surgery every 15 minutes for 2 hours. Results: Based on the statistical analysis of the patients' data, the mean heart rate and pain intensity scores in the ketamine-remifentanil group were significantly lower than those in the ketamine-propofol group (P 0.05). The incidence of nausea was higher in the ketamine-remifentanil group and the decrease in oxygen saturation was higher in the ketamine-propofol group (P 0.05). Conclusion: Based on the results of this study, it seems that use of ketamine-remifentanil combination in comparison to ketamine-propofol in closed reduction of nasal fracture is associated with greater hemodynamic stability, higher analgesic effect and fewer complications.

Keywords

• nasal fracture
• pain
• propofol
• ketamine
• remifentanil
• hemodynamic changes