Comparative study between Ketamine and Propofol versus Ketamine and Dexmedetomidine for Monitored Anaesthesia Care for Dilatation and Curettage surgeries in Day Care procedure

Abstract

Introduction. Anaesthesia is frequently administered through Monitored Anaesthesia Care (MAC) utilising various combinations of anaesthetic drugs for moderately painful operations like Dilatation and Curettage (D&C) which is preferably done as a day care procedure. The hunt for improved drug combinations is always ongoing and it takes into account the pharmacological properties of the individual drugs. In this regard, anaesthesiologists all over the world are quite fond of the combination of Ketamine and Propofol, which was also known as Ketofol. Recently, especially in situations involving MRI sedation, the combination of ketamine and dexmedetomidine (Dexket) has gained popularity. In this study we compare both the combinations for MAC during D&C surgeries in a day care setting. Aim. The primary objective was to estimate the recovery times using either combinations. Secondarily we would also compare the duration of analgesia, the hemodynamic and side-effect profile of the two combinations. Material and Methods. This study enrolled 60 patients posted for elective D&C. According to standard institutional protocols they were either administered Ketofol(KP group) or Dexket(KD group) depending on anaesthesia providers choice. Ketofol group received Ketamine 1mg/kg and Propofol 1mg/kg and with boluses of ketamine 0.25mg/kg to maintain depth of anaesthesia using Ramsay sedation score(RSS) >3. KD group received Dexmedetomidine intravenously 1mic/kg over a period of 10 minutes followed by ketamine 1mg/kg followed by boluses of Ketamine 0.25mg/kg to maintain adequate anaesthetic depth of RSS>3. Results. The Recovery time in post operative period was significantly prolonged in the KD group (mean 22.77 minutes) compared to KP group (mean 17.8 minutes). Total duration of analgesia was also longer in KD group (250 minutes vs 220 minutes in KP group). It was seen that the hemodynamic variables (HR, SBP, DBP) were consistently higher in the KD group compared to the KP group. There was a significant difference in SBP, DBP, MAP in intraoperative period between KP and KD group till 4hr in the post operative period. Conclusions. We conclude that combination of Dexmedetomidine and Ketamine has longer recovery times and duration of analgesia compared to combination of Propofol and Ketamine. Side effects like post operative nausea and vomiting are not significant. But since the recovery times are comparatively longer in a day care setting. Dexmedetomidine and Ketamine may not be the preferred agent as compared to the combination of Ketamine and Propofol in the context of day-care setting.

Keywords

• DEXKET
• KETOFOL
• Monitored Anaesthesia Care
• Dilatation and Curettage