A COMPARISON OF PROPOFOL WITH A PROPOFOL-KETAMINE COMBINATION FOR SEDATION DURING SPINAL-ANESTHESIA

Propofol (P) is increasingly used as a sedative during regional anesth esia. Providing titratable sedation and rapid recovery, it can comprom ise hemodynamic stability. However, in combination with ketamine (K), it provides stable hemodynamics during total intravenous anesthesia, a voiding emergence phenomena. We compared the efficacy, respiratory and hemodynamic profiles, and side effects of these two sedative regimes in patients undergoing spinal anesthesia. Forty patients, ASA physical status I and II, undergoing urologic or orthopedic procedures were ra ndomly assigned to one of two groups (n = 20 each). Group 1 (P + K) re ceived initial doses of 0.4 mg/kg P, 0.1 mg/kg K, followed by an intra venous infusion of 1.2 mg.kg(-1).h(-1) and 0.3 mg.kg(-1).h(-1), respec tively. Group 2 (P) received bolus 0.5 mg/kg and infusion 1.5 mg.kg(-1 ).h(-1). Subsequent infusion rates were titrated to a predetermined se dation level using a 5-point score. Heart rate, arterial pressure, res piratory rate, oxygen saturation end-tidal CO2, and oxygen requirement s were recorded. Sedation scores were similar for both groups. There w as no difference in total propofol requirements between Group 1 (146 /- 94 mg) and Group 2 (137 +/- 52 mg) (mean +/- SD). Mean arterial pre ssure was significantly higher in the P + K group, e.g., 91 mm Hg (86- 94) vs 75 mm Hg (69-83) at 30 min (mean +/- SD). Administration of vas opressors and fluids as well as recovery and emergence phenomena were similar between groups. Although the described additive effect of prop ofol and ketamine was not confirmed, the combination conferred hemodyn amic stability during spinal anesthesia.