Effects of subanesthetic ketamine on pain and cognitive functions in TIVA TİVA’da subanestezik ketaminin ağrı ve kognitif fonksiyonlara etkisi
Journal of Clinical and Analytical Medicine, cilt.6, sa.4, ss.452-457, 2015 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 6 Sayı: 4
- Basım Tarihi: 2015
- Doi Numarası: 10.4328/jcam.2161
- Dergi Adı: Journal of Clinical and Analytical Medicine
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.452-457
- Anahtar Kelimeler: Ketamine, Anesthesia Intravenous, Cognition Disorders
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Aim: It was aimed to compare the effects of subanesthetic dose ketamine on analgesic consumption, cognitive functions, perioperative hemodynamics and postoperative recovery in patients scheduled for laparoscopic cholecys-tectomy under total intravenous anesthesia (TIVA). Material and Method: The study was approved by Institutional Ethics Committee and all patients gave written informed consent. Sixty ASA I-III patients aged 20-70 years sched-uled for elective laparoscopic cholecystectomy were randomly assigned into 2 groups [group 1 (TIVA-ketamine) and group 2 (TIVA)]. Both groups underwent Mini Mental Test (MMT) before the operation. In the group 1, 0.25 mg.kg-1 ketamine was given 2 minutes before induction via intravenous route. Anesthesia was induced by using 2mg.kg-1 propofol, 1μg.kg-1fentanyl (iv) and 0.6 mg.kg-1 rocuronium (iv) in both groups. Anesthesia was main-tained by 5-8mg.kg-1.h-1 propofol, 0,15μg kg-1 remifentanil (iv) and 50:50 mixtures of O2 and air. Postoperative pain management was achieved by tramadol HCl via patient-controlled analgesia (PCA) device. Total dose within 24 hours was recorded. Hemodynamic parameters during surgery and times to extubation, eye opening, receiving verbal commands and orientation time were recorded. Ramsey sedation score (RSS) and Aldrete recovery score (ARS) were recorded after extubation. MMT was repeated on the postopera-tive hour 24. Results: Hemodynamic parameters were found to be similar in both groups. Total analgesic consumption was found to be significantly lower in patients received ketamine (p<0.001). ARSs on minutes 5 and 10 were found to be lower in ketamine group (p=0.05). RSSs were found to be higher in ketamine group (p=0.05). Times to extubation, receiving verbal commands and orientation were found to be longer in ketamine group (p=0.05). There was no significant difference regarding baseline and postoperative values of MMT as well as patient satisfaction between groups (p>0.05). Discussion: Addition of subanesthetic dose ketamine to total intravenous anesthesia had no adverse effect on intraoperative hemodynamic parameters; it provided more effective postoperative analgesia; however, we think that a meticu-lous monitoring is required during early postoperative period as it prolonged awakening and recovery times.