Propofol Versus Propofol-Ketamine Sedation for Retrobulbar Nerve Block

Frey, Kere; Sukhani, Radha; Pawlowski, Julius; Pappas, Ana Lucia; Mikat-Stevens, Marianna; Slogoff, Stephen

doi:10.1097/00000539-199908000-00013

Cited by 30 publications

(14 citation statements)

References 12 publications

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“…[37] The incidence and mean duration of apnea in the present study were higher in the propofol group than in the ketofol group. Consistent with our results, previous studies[161833] concluded that the addition of ketamine to propofol is associated with less prolonged apnea and less risk of respiratory depression compared with propofol alone. Also low-dose ketamine added to propofol sedation attenuated propofol-induced hypoventilation and preserved response to carbon dioxide.…”

Section: Discussionsupporting

confidence: 93%

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A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children

Yousef

Elsayed

2013

Anesth Essays Res

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Background:In spite of being the preferred induction agent for LMA insertion, propofol has many undesirable side effects including dose-related cardiorespiratory depression and local pain at injection site. Ketofol as a novel induction agent has been introduced recently with comparable efficacy and improved hemodynamic controlObjective:To investigate ketofol as a suitable induction agent alternative to propofol for insertion of LMA in children considering insertion conditions, hemodynamic stability, local pain at injection site, and recovery.Materials and Methods:In this randomized, double-blind study, 100 children were randomly assigned into two groups of 50 patients each in which induction was performed with either propofol or ketofol. Providers were given one 20 ml syringe [represent either 2 mg/kg of propofol (P group) or 0.75 mg/kg of ketamine and 1.5 mg/kg of propofol (KP group)] and one 10 ml syringe for rescue if needed [represent 1 mg/kg of propofol (P group) or 0.25 mg/kg of ketamine and 0.5 mg/kg of propofol (KP group)]. After monitoring with bispectral index (BIS), general anesthesia was induced by infusion with a syringe perfuser at a constant rate of 250 ml/h with either of the two agents till the BIS values decreased to 40. Mean arterial pressure (MAP), heart rate (HR) were measured every 30 seconds up to 5 minutes after LMA placement. The time till BIS values decreased to 40 was measured. All children were evaluated for incidence of apnea, pain on injection, jaw relaxation, conditions for LMA insertion, and complications such as muscle rigidity, hallucinations, and excessive secretions.Results:Induction time (time to reach BIS of 40) was faster in the KP group (150 ± 23.5 seconds) than in the P group (205 ± 37.4 seconds). The incidence of injection pain was significantly lower in the KP group (10%) than in the P group (80%). Excellent jaw relaxation and full mouth opening were higher in the KP group [45 patients (90%)] than in the P group [38 patients (76%)]. Excellent LMA insertion conditions were observed in 45 patients (90%) in the KP group and 38 patients (76%) in the P group. The KP group showed preserved hemodynamic stability (mean blood pressure, heart rate) with less incidence and duration of apnea compared to the P group.Conclusion:ketofol is a safe and effective alternative induction agent for LMA insertion in children with rapid onset of action and lower incidence of injection pain. It provided better LMA insertion conditions, improved hemodynamic stability with less prolonged apnea when compared with propofol.

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Section: Discussionsupporting

confidence: 93%

“…Consistent with our results, Frey and colleagues[18] stated that ketofol was associated with shorter time until sedation compared to propofol. Induction time (time to reach BIS of 40) was faster in the ketofol group (150 ± 23.5 seconds) than in the propofol group (205 ± 37.4 seconds).…”

Section: Discussionsupporting

confidence: 92%

A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children

Yousef

Elsayed

2013

Anesth Essays Res

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“…Various sedative and analgesic drug regimens prior to the placement of local anaesthesia for cataract surgery have been investigated [12, 13, 14, 15, 16]. The ideal drug should render the patient pain free and immobile during the placement of peribulbar block and surgery and should be free of side-effects.…”

Section: Discussionmentioning

confidence: 99%

“…Many single- and multiple-drug regimens have been investigated for use prior to the placement of ophthalmic nerve blocks [12, 13, 14, 15, 16]. But new intravenous regimens continue to be evaluated because so far, none resolved all problems such as airway obstruction, over-sedation and respiratory or cardiovascular depression.…”

Section: Introductionmentioning

confidence: 99%

Use of Piritramide for Analgesia and Sedation during Peribulbar Nerve Block for Cataract Surgery

Reinhardt

Burkhardt²,

Nestler³

et al. 2002

Ophthalmologica

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Purpose: To investigate the effects of pre-block analgesia and sedation using piritramide on haemodynamic stability, endocrine stress response and patients’ pain perception. Methods: In a randomized, single-blinded, placebo-controlled study, 60 patients having cataract surgery with peribulbar block were randomly assigned into two groups: group A (n = 30) received 0.05 mg/kg piritramide (Dipidolor^®) intravenously; group B received normal saline intravenously prior to peribulbar block. Mean arterial pressure, heart rate, respiratory rate and pulse oximetry were recorded perioperatively. Pain from peribulbar block was assessed using a verbal analogue scale. Urinary excretion of vanillylmandelic acid was measured to assess the endocrine stress response. Using a questionnaire, patients assessed their anxiety and back pain before and during surgery. Results: Mean arterial pressure remained near baseline in group A. In group B, a significant increase in mean arterial pressure after peribulbar block was found (p < 0.001). In addition, a significant increase in urinary excretion of vanillylmandelic acid was found in group B (p = 0.013). Pain scores (p < 0.001), anxiety before nerve block (p = 0.02) and during surgery (p < 0.001) and back pain (p = 0.003) were significantly lower in group A. Conclusion: The presented study suggests that using piritramide for analgesia and sedation prior to peribulbar block produces haemodynamic stability and reduces pain perception and endocrine stress response.

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“…Monitored anesthesia care (MAC) is performed without regional anesthesia to improve the patient's postoperative condition in vascular procedures. The most commonly used agents for MAC are midazolam, propofol, and fentanyl [1,2,3]. It is well known that a combination of these drugs is often difficult to titrate and may induce respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

The comparison of monitored anesthesia care with dexmedetomidine and spinal anesthesia during varicose vein surgery

et al. 2014

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PurposeThe purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery.MethodsForty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 µg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 µg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups.ResultsSystolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery.ConclusionWe believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition.

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Propofol Versus Propofol-Ketamine Sedation for Retrobulbar Nerve Block

Abstract: Anesthesiologists frequently perform retrobulbar blocks while simultaneously providing sedation. Using ketamine to supplement propofol sedation provided a faster onset and improved the quality of sedation during the retrobulbar block procedure.

Cited by 30 publications

References 12 publications

A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children

A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children

Use of Piritramide for Analgesia and Sedation during Peribulbar Nerve Block for Cataract Surgery

The comparison of monitored anesthesia care with dexmedetomidine and spinal anesthesia during varicose vein surgery

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