TIVA
Advantages of Propofol
Smooth & Rapid induction (Gerald Edelist etal ,
1987)
Rapid & clear headed recovery ( Kashtan H etal ,
1990)
Less postop nausea & vomiting (Myles P.S. etal ,
1996)
Minimum inhibition of cortisol production(Kenyou
CJ etal1985)
No interaction with haem synthesis (Kenyou CJ etal,
1985)
Aims & Objectives
To compare Propofol as a sole
anaesthetic agent with Ketamine in
paediatric day care surgery in view of
Preoperatively
Afterpremedication
Immediately after induction
At 5min interval for first 30min
Every 10min there after upto 2hrs postoperatively
Material & Methods
ambulatory anaesthesia
Levels of conciousness : Awake(2) / Arousable with minimal
stimulation(1) / Responsive only to tactile stimulation(0)
Physical Activity : Able to move all extremities on command(2) / Some
weakness in movement of all extremities(1) / Unable to voluntarily move the
extremities(0)
Haemodynamic Stability : Blood pressure <15% of the baseline MAP
value(2) / Blood pressure between 15% and 30% of the baseline MAP
value(1) / Blood pressure >30% below the baseline MAP value(0)
Respiratory Stability : Able to breathe deeply(2) / Tachypnea with good
cough(1) / Dyspneic with weak cough(0)
Oxygen Saturation Status : Maintain value > 90% on room air(2) /
Requires supplemental oxygen (nasal prongs)(1) / Saturation < 90% with
supplemental oxygen(0)
Postoperative pain assessment : None or mild discomfort(2) / Moderate to
severe pain controlled by i.v. analgesics(1) / Persistent severe pain(0)
Postoperative Emetic Symptoms : None or mild nausea with no active
vomiting(2) / Transient vomiting or retching(1) / Persistent moderate to severe
nausea and vomiting(0)
Demographic Profile
Parameters Group I Group II
No: of patients 50 50
42.02
42.2
42
41.8
41.6
41.4
41.2 40.78
41
40.8
40.6
40.4
40.2
40
I II
Group
Dose Requirement for Induction
49
50 42.4
45
40
35
30
25
20
15
10 2.48 2.2
0
I II
GROUP
200
150
118. 3
Mean
100 79. 16
70. 9
50
0
Inf usion rate ( µg/ kg/ min) Total maintenanc e dose ( mg) Total dose ( mg)
Gr oup I Gr oup I I
Supplementation of Drug for
maintenance
28
30
22
25
20
15
10
0
I II
GROUP
Distribution according to duration
of Anaesthesia
40
36
34
35
Patients (%)
30
24
25 22 22
20
20
15 12
10
10
6 6
4 4
5
0
25-35 36-45 46-55 56-65 66-75 >75
TIME (min)
Group I Group II
Distribution according to duration
of surgery
40
34
35
32
Patients (%)
30
24
25
22 22
20
20
16
T
15
12
10
10
4
5
2 2
0
15-25 26-35 36-45 46-55 56-65 >65
Time (min)
Group I Group II
MEAN (BPM)
90
95
100
105
110
115
120
Pre
operative
After pre
medication
After
induction
10 minutes
after
20 minutes
after
30 minutes
after
Group I
40 minutes
after
interval
50 minutes
after
Group II
60 minutes
after
70 minutes
after
80 minutes
after
90 minutes
after
Mean Heart rate at various time
Post
operative
MEAN (mmHg)
0
20
40
60
80
100
120
140
Pre
operative
After pre
medication
After
induction
10 min
after
20 min
after
30 min
after
Group I
40 min
after
50 min
after
Group II
60 min
after
70 min
after
various time intervals
80 min
after
90 min
after
Post
Mean Systolic arterial pressure at
operative
MEAN (mmHg)
0
10
20
30
40
50
60
70
80
90
Pre
operative
After pre
medication
After
induction
10 min
after
induction
20 min
after
induction
30 min
after
induction
40 min
Group I
after
induction
50 min
after
induction
60 min
Group II
after
induction
70 min
after
induction
80 min
at various time interval
after
induction
90 min
after
induction
Mean Diastolic arterial pressure
Post
operative
Mean RR
0
5
10
15
20
25
Pre operative
After
premedication
After
induction
10 mmin after
induction
20 mmin after
induction
30 mmin after
induction
40 mmin after
induction
50 mmin after
induction
60 mmin after
induction
70 mmin after
induction
time interval
80 mmin after
induction
90 mmin after
induction
Post operative
Mean Respiratory rate at various
Group I
Group II
PERCENTAGE
0
5
10
15
20
25
30
14
Pain on
0
injection/Thrombophlebitis
24
Spontaneous movements
10
28
Apnoea
8
2
Laryngospasm /
Bronchospasm
10
0
Nystagmus
26
complications
Emergence phenomenon
12
4
Nausea / Vomiting
16
Incidence of perioperative
Group I
Group II
Fast Track Eligibility Criteria at
various time interval
100
96
92
100
90 80
Patients (%)
80
70
60
46
50
40 28
30
20
10
Time
Gr oup I Gr oup I I
Quality of Anaesthesia
80
80
60 50
Patients(%)
40
40
20
20 10
0
Excellent Good Poor
GroupI GroupII
Summary
There was no significant difference in induction dose &
induction time b/w the two groups
Infusion rate for maintenance of anaesthesia is more in
propofol group
Arterial B.P. decreased in Propofol group & increase was
seen in Ketamine group
Increase in Heart rate is less with Propofol
Incidence of Apnoea is more with Propofol
Pain on injection was seen only with Propofol
Incidence of Spontaneous movement was more in Propofol
group
Laryngospasm / Bronchospasm was more in Ketamine
group
Conclusion