COMPARISON OF INTRAVENOUS KETOROLAC AND ALFENTANIL AS SUPPLEMENTS TO PROPOFOL ANESTHESIA FOR DIAGNOSTIC PANENDOSCOPY

Study Objective: To determine if ketorolac tromethamine is an acceptab le alternative to alfentanil as a supplement to propofol for diagnosti c panendoscopy. Design: Randomized, double-blind study. Setting: Unive rsity medical center. Patients: 40 patients scheduled for panendoscopy and laryngeal tissue biopsy. Interventions: Patients were randomly as signed to receive either alfentanil 14.5 mu g/kg or Ketorolac 1.0 mg/k g in a double-blind fashion, 5 to 10 minutes before induction of gener al anesthesia. Measurements and Main Results: Heart rate (HR) and noni nvasive blood pressure (BP) were measured and recorded before and imme diately after injection of the study drug; after laryngoscopy for the endotracheal tube placement, and after initiation of diagnostic panend oscopy. Bleeding in the operative, field was rated try the endoscopist . Observation from discontinuation of the propofol infusion and nitrou s oxide inhalation to eye opening, head lifting, and orientation to ti me and place was observed and recorded. The presence of stridor after extubation, and pulse oximeter-determined arterial blood oxyhemoglobin saturation immediately after extubation and 5 minutes later, were not ed. In the recovery room, the ability to tolerate oral fluids, sit, st and, and walk were recorded. Supplementation with ketorolac provides f aster recovery from anesthesia as evidenced by shorter time to eye ope ning, head lifting, and orientation to time and place. However, no int ergroup differences were found in measured intraoperative variables (B P and HR following laryngoscopy, tracheal intubation, diagnostic panen doscopy, and tissue biopsy). Operative site bleeding was comparable in both groups. The variables reflecting street readiness and the incide nce of nausea and vomiting were statistically comparable. Conclusion: Supplementation of propofol anesthesia with ketorolac is an efficaciou s alternative to supplementation with alfentanil. The faster recovery in the ketorolac group is explained by the mostly peripheral effect of this drug, whereas the slow decline in the alfentanil concentration a t the effective site may be responsible for slower emergence from anes thesia.