Mortero et al. Anesth Analg 2001; 92:1465-9

Reviewed by: R. Prasad, MD

Summary:

• 40 ASA I-III pts, randomized, double-blinded.
• Excluded: morbid obesity, psychological problems, use of CNS-effecting drugs, substance abuse, chronic pain, pregnancy, sz DO, increased ICP, cardiovascular/hepatic/renal/psychiatric dz
• Group P: n=20. Propofol
• Group PK: n=20. Propofol 9.8 mg/ml with ketamine 0.98mg/ml
• Protocol
• Premed midaz 1-3mg, fent 50mcg
• Then, bolused with 1-3ml study drug
• Maintenance: infusion 0.3-0.5 cc/kg/min study solution
• Gtt adjusted to level of sedation. Fentanl ginve as needed for pain.
• PACU: MSO4 as needed. PONV tx'd with 4mg Zofran
• Self-assessments by VAS, before and after surgery:
• perception (body, surroundings, time, reality, colors, sound, voices, meaning)
• mood (anxiety, hostility, depression, confidence, energy level, confusion)
• cognition (MMSE, thought control, content)
• Pain and activity after discharge home also assessed

• Demographics, type/duration surgery, amounts propofol/fentanyl, BP, HR, SpO2, sedation level, # adverse events (5%) similar
• RR slightly higher (~16 vs ~14), ETCO2 lower (~30 vs. ~47) in PK
• Mood 15 min after arrival to PACU: both groups better than preop. PK better than P.
• Cognition better in PK, with no adverse effects (paranoia, weird feeling, thought process) detected
• Perception mildly impaired in P, resolved by 30min postop.
• Pain (rest or activity), amt hydrocodone lower, activity level higher in PK in POD #1. Return to normal activity level sooner in PK (POD #2 vs. #4)

• Small study
• Still, ketamine looks pretty good. We've been talking about this for years (and even presented an abstract way way back in 1995) ... perhaps we should more routinely start mixing ketamine to propofol?