A comparative study of efficacy of three different proportions of ketamine and propofol in minor gynaecological procedures

An ideal intravenous anaesthetic agent to be considered for day-care surgery should provide rapid recovery with very less side effects and available at a reasonable cost. Both ketamine & propofol has all these characteristics but however cause significantly opposing hemodynamic effects which can be detrimental in patients with high risk, if used as sole induction agent.

To assess and compare the efficacy of three different proportions of intravenous propofol-ketamine combination in minor gynaecological procedures.

A prospective comparative study was done on 120 patients at Vinayaka Missions Medical College Hospital by the anaesthesia department among the females who had been posted for minor gynaecological procedures. The study subjects were classified into 3 groups of 40 each. The anaesthetic drug administered for each group is as follows Group I-Propofol 1.5mg/kg + Ketamine 0.5mg/kg; Group II-Propofol 1.5mg/kg + Ketamine 1.0mg/kg and Group III-Propofol 1.5mg/kg + Ketamine 1.5mg/kg. The vital parameters were measured immediately(1 min.) after the drug (Propofol-Ketamine combination) administration and then after every 5 minutes upto half an hour. Adequacy of depth of anesthesia will be analysed by using EVANs(1987) scoring system. Requirement of airway intervention by means of bag and mask ventilation were recorded. Untoward events like vomiting or emergence phenomena during recovery were carefully watched and recorded.

The systolic BP and the mean heart rate was much lower in group 1 and it was highest among group 3. The mean time of maintaining the adequate depth of anaesthesia without giving supplement dosage, which was assessed by using EVANS scoring had shown that among the group I patients it was much lower when compared with group II and III and the difference was found to be statistically significant (P<.05). The air way intervention in the form of bag and mask ventilation was required by 82.7% of the patients in group III when compared to 7.5% in group I and the difference was found to be statistically significant. The recovery from anaesthesia by taking into consideration of the supplemental dose, was found to be very high in group III patients than that of group I and II and the difference was found to be statistically significant.

Of the three different doses of ketamine with a fixed dose of propofol (1.5mg/kg), ketamine 1mg/kg was found to be a better dose when compared to 0.5mg/kg and 1.5mg/kg for day care gynaecological procedures.