The Comparison of Characteristics in Emergence between Inhalational Anesthesia Using Isoflurane and Total Intravenous Anesthesia Using Propofol and Ketamine

Lee, Bo Ryoung; Oh, Soo Won; Jung, Yong Hun

Abstract

BACKGROUND: Total intravenous anesthesia (TIVA) is one of the anesthetic techniques that needs no inhalational agent but only an intravenous agent for induction and maintenance of anesthesia. Among drugs used in TIVA, propofol is the most popular agent. Rapid emergence and antiemetic characteristics of propofol are well known advantages but a dose dependent cardiovascular depressant effect is one of the disadvantages of this drug. Otherwise, ketamine, a dissociative agent, has been restricted in its use because of bad dreams, delirium and delayed emergence even though it has profound analgesic characteristics. However, ketamine has a stimulatory effect on the cardiovascular system, so it can raise blood pressure and pulse rate and in the case of TIVA, these properties can be advantageous when used with propofol. This study was aimed to decide whether TIVA using propofol and ketamine would have more stable vital signs during anesthesia and more rapid and smoother emergence in comparison with inhalational anesthesia using isoflurane.
METHODS
Thirty two patients scheduled for elective general anesthesia were randomly allocated into two groups; I (inhalational anesthesia using isoflurane) group and PK (TIVA using propofol and ketamine) group. I group was controlled with isoflurane 1 - 1.5 vol% and the PK group was controlled with propofol 3 - 12 mg/kg/hr and ketamine 0.5 - 1.0 mg/kg/hr. Arriving at the recovery room, a single observer recorded the time to spontaneous movement, responses to painful pinch and verbal command, and orientation to age, name, place, date and time. At 5, 10, and 30 minutes after anesthesia, a PARS (postanesthesia recovery score), count-down test, and VAS (visual analogue scale) were checked. Postoperative events were checked in the recovery room and 24 hours lator.
RESULTS
There was no significant difference in demographic data or characteristics of operation. Compared with the I group, the PK group had significantly rapid orientation responses on place, date and time. Restoration in the count-down test was more rapid in the PK group after 10 minutes in the recovery room. The VAS was lower in the PK group after 30 minutes in the recovery room.
CONCLUSIONS
TIVA using propofol and ketamine has a more rapid emergence than inhalational anesthesia using isoflurane and better postoperative analgesic effect without respiratory depression.