Comparison Between Low Dose Ketamine VS Fentanyl Combined with Propofol in Patients Scheduled for Fractional Curettage; A Randomized Controlled Trial

Abstract

Objective: Total intravenous anesthesia for uterine curettage with propofol is common in practice. Narcotics are used to decrease movement due to pain during the procedure. But narcotics may cause hypotension, hypoventilation, bradycardia, desaturation and apnea.  We hypothesized that the use of ketamine instead of fentanyl can reduce the incidence of patients’ movement and other complications mentioned above.
Methods: Eighty-four patients were enrolled into the study. The patients were randomized in to 2 groups: Fentanyl group (Propofol+Fentanyl) and Ketamine group (Propofol+Ketamine). Low dose of ketamine (0.3 mg/kg) or fentanyl (1 mcg/kg) was injected, followed by propofol 1.5 mg/kg, then uterine curettage was started along with propofol infusion of 5 mg/kg/hr. Patients’ movement, respiratory rate, blood pressure, and O2 saturation were recorded every  minute. After the procedure, the emergence duration and surgeon’s satisfaction were recorded. The incidence of nausea/vomiting, dizziness and any other complaints were recorded for 24 hours postoperatively.
Results: There was no significant difference in patient’s movement, surgeon’s satisfaction and emergence duration between the two groups. Patients in ketamine group significantly showed lower incidences of respiratory depression as shown by less requirement of airway manipulation with assisted ventilation, and lower incidences of hypotension than patients in the fentanyl group (2.4% vs. 19%, p=0.029 and 7.2% vs. 52.4%, p<0.01, respectively).
Conclusion: The use of low dose ketamine with propofol in patients having uterine curettage can cause less hypotension and less respiratory depression than using fentanyl with propofol, without any difference in patients’ movements and emergence from anesthesia.

Keywords: Ketamine, TIVA, movement, curettage, fentanyl