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Dissertation Chapters | Anaesthesiology | India | Volume 12 Issue 4, April 2023
Evaluating Effect of Intraoperative Infusion of Low Dose Ketamine on Hemodynamics and Postoperative Pain amongst Patients Undergoing Abdominal Surgery under General Anesthesia; A Prospective Observation Study
Dr. Arshiya I Shaikh | Dr. Jignasa J Patel | Dr. Neelam Parmar | Dr. Tejal A Chaudhari
Abstract: Background: Major abdominal surgeries are associated with large fluid shifts and blood loss intra-operatively and significant pain postoperatively. Ketamine has unique sympathomimetic property, opioid sparing effect and intense analgesic property even in subanesthetic dose. So, this study was planned to evaluate the effect of low dose ketamine infusion on intraoperative hemodynamics, opioid requirements and postoperative pain. Method: A prospective observational comparative study was conducted on 60 patients of either sex in age group of 18 - 60 years belonging to ASA class III and IV. GA was given with STP, scoline, vecuronium/atracurium and sevoflurane. 30 patients in Group K received injection Ketamine 0.5 mg/kg bolus followed by 0.25 mg/kg infusion while 30 patients in Group C did not received Ketamine. Intraoperative hemodynamic parameter and opioid requirement were noted. Postoperative quality of pain was evaluated through VAS score up to 12 hours. First rescue analgesic time, cumulative tramadol consumption, total number of doses of rescue analgesics within 12 hours and side effects were noted. Results: The mean age, mean weight and mean duration of surgery were comparable between both the groups (P>0.05). Intergroup comparison of mean preoperative pulse rate and mean preoperative blood pressure was comparable (P>0.05), intragroup comparison of intraoperative hemodynamics was more stable in ketamine group when compared to baseline. Postoperative mean VAS score difference was statistically significant for first 3 hours (P<0.05). First rescue analgesic requirement was 222 minutes in Group K and 110 minutes in Group C (P=0.014). 26% of patient in Group K and 63% of patients in Group C required ? 2 doses of tramadol postoperatively. Cumulative tramadol requirement was more in Group C as compared to Group K (193.33 ? 90.17 mg VS 286.6 ? 84.4 mg, P = 0.002). 43% patients in Group K had an emergence reaction which were treated with an incremental dose of midazolam. The required mean dose of midazolam was 1.11 mg. Conclusion: Intraoperative low dose ketamine infusion provides stable intraoperative hemodynamics and perioperative analgesia, with its potent opioid sparing effect and it should be considered as an effective and safe component of multimodal analgesia.
Keywords: ketamine, subanesthetic dose, hemodynamics, Fentanyl, postoperative pain
Edition: Volume 12 Issue 4, April 2023,
Pages: 926 - 930