A Comparative Evaluation of Two Tiva Techniques for Day Care Surgical Procedures– Midazolam and Ketamine Versus Fentanyl and Propofol

Abstract

BACKGROUND TIVA has gained popularity recently partly in order to reduce pollution by volatile agents. The present study was designed to evaluate the comparison of Total intravenous anaesthesia (TIVA) techniques: Midazolam-Ketamine and Propofol-Fentanyl for their cardiovascular effects, intraoperative and postoperative complications and recovery profile. MATERIALS AND METHODSThe study was a non-randomised clinical trial. After approval of the hospital ethical committee, hundred patients from either sex ranging from 20-60 years of age, undergoing short surgical procedures less than an hour of ASA grade I and II were included in this study. The patients were randomly allocated into two Groups of 50 patients each. Group A received injection midazolam 0.05 mg/kg IV and injection glycopyrrolate 0.2 mg IV one minute before injection Ketamine 2 mg/kg IV given over 60 seconds. Thereafter ketamine infusion was started at 50 mcg/kg/min. Group B received injection fentanyl 2 mcg/kg IV. and injection glycopyrrolate 0.2 mg IV one minute before the injection propofol 2.5 mg/kg IV given over 60 seconds. Thereafter, propofol infusion was started at 200 mcg/kg/min. The various parameters studied were induction time, pain on injection, heart rate, respiratory rate, SpO2, recovery time by using Modified Steward Coma Score. RESULTSIn Group A, there was statistically significant rise in heart rate (HR) and mean arterial pressure (MAP) 15 minutes (T15) after induction whereas in Group B there was non-significant fall in HR 25 minutes after induction (T25) but statistically significant fall in MAP at T5. Recovery profile was assessed by Modified Steward Coma Score. In Group A, maximum number of patients i.e. 25 patients have score of 6, 15 minutes after stopping ketamine infusion whereas in Group B 30 patients had score of 6, 5 minutes after stopping propofol infusion. CONCLUSION