RESUMEN
PURPOSE: Both ketamine and priming may shorten the onset time of rocuronium. This study investigates the effects of ketamine and priming as components of a propofol induction on intubating conditions and onset of neuromuscular block. METHODS: This prospective randomized double-blind study was performed in 120 American Society of Anesthesiologists (ASA) I-II patients who were assigned to one of four groups of 30 patients each: control, priming, ketamine, and ketamine-priming. Ketamine 0.5 mg x kg(-1) or saline was given before priming and induction. Rocuronium 0.06 mg x kg(-1) or saline was injected 2 min before propofol 2.5 mg x kg(-1). This was followed by rocuronium 0.6 mg x kg(-1) or by rocuronium 0.54 mg x kg(-1) if priming was given. Intubation was performed one minute later. Intubating conditions were graded as excellent, good, or poor. Heart rate, noninvasive blood pressure, and train-of-four (TOF) response were monitored. RESULTS: Intubating conditions were graded excellent in 20% of the control group, 30% of the priming group, 47% of the ketamine group, and 57% of the ketamine-priming group. Analysis using forward stepwise regression indicated that ketamine improved intubating conditions (P = 0.001) but priming did not (P = 0.35). Time to reach a TOF count of zero was shortened by ketamine (P = 0.001) but not by priming (P = 0.94): 216 +/- 20 s in the control group, 212 +/- 27 s in the priming group, 162 +/- 18 s in the ketamine group, and 168 +/- 22 s in the ketamine-priming group. CONCLUSION: A low-dose ketamine used with a propofol-rocuronium induction improved intubating conditions and shortened onset time. Priming did not influence intubating conditions or onset time.
Asunto(s)
Androstanoles/uso terapéutico , Intubación Intratraqueal/métodos , Ketamina/uso terapéutico , Propofol/uso terapéutico , Adulto , Analgésicos/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes/uso terapéutico , Estudios Prospectivos , Análisis de Regresión , Rocuronio , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: Extracorporeal Shockwave Lithotripsy (ESWL) is an effective and safe way for treatment of upper urinary system stones. For pediatric patients, throughout ESWL, sufficient sedation and analgesia is needed to cope with the procedural pain. In this study, our goal was to compare 2 methods of intravenous anesthesia, applied to pediatric patients during ESWL. METHODS: Forty patients, between 3 months and 15 years of age who were admitted to the Faculty of Medicine, Hacettepe University, Turkey between September 2003 to September 2004 with upper urinary system calculi were randomized into 2 groups. All patients received intranasal midazolam 0.3 mg/kg premedication. Group K received intravenous (iv) ketamine 2 mg/kg; Group PF received a bolus of iv propofol 3 mg/kg and iv fentanyl 1 microg/kg along with a propofol infusion of 1 mg/kg/hr throughout the procedure. Procedural, recovery and discharge times, incidences of intra and post-procedural complications were compared. RESULTS: Demographics, procedural and discharge times were similar in 2 groups. While recovery times and post-procedural complication incidence was higher for the Group K, intra-procedural complication incidence was higher for the Group PF. CONCLUSION: Although both protocols do not differ much according to ease of application and efficacy in providing sufficient analgesia for ESWL, they have their corresponding side effects and they can only be practiced safely by experienced anesthesiologists in a monitorized and well equipped setting.