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Dexmedetomidine Premedication With Ketamine and Propofol During Burns Debridement and Dressings
Dexmedetomidine Premedication With Ketamine and Propofol During Burns Debridement and Dressings
INTRODUCTION
bility [3].
Burn pa ents undergo frequent extensive burn deb- Ketamine and Propofol are the most common anes-
ridement and painful dressing changes. During these the c used along with Opioids and Benzodiazepines in
procedures the pa ent requires anesthe c agents to burns dressings. The addi on of these anesthe cs to a
provide necessary deep seda on, along with analgesia. regimen of Opioids and Benzodiazepines for dressing
Along with the anesthe c agents Opioids and Benzodi- not only decreases the Opioid and benzodiazepine re-
azepines are the most commonly used group of drugs. quirements but also facilitate improved compliance
Frequent use of Opioids and Benzodiazepines leads to with physical and occupa onal therapy leading to a
tolerance to the analgesia and seda on [1,2]. Tolerance decreased incidence of heterotopic ossifica on [4].
to Opioids and Benzodiazepines leads to increase in Ketamine has been a safe and effec ve anesthe c
doses in order to maintain adequate seda on and anal- agent for burns dressings with a few limita ons such as
gesia during the procedure. The most common prob- delayed recovery, emergence phenomenon, and nau-
lems associated with significant burns (>20% total body sea and vomi ng [5].
surface area) are prolonged recovery with high Opioid Propofol have favorable pharmacokine cs but it lacks
and benzodiazepine a er each dressing change and the analgesic property intrinsic to Ketamine [6]. Fenta-
heterotopic ossifica on as a result of pain-limited mo- nyl is added to Propofol to compliment the analgesic
property. Recently Dexmedetomidine (Dex), a highly
selec ve α2-adrenoreceptor agonist, is used for seda-
DOI: 10.5455/ijcbr.2017.34.14 on in various clinical se ngs and shows an anesthe c-
sparing effect [7-11]. Studies have shown that concomi-
tant Dexmedetomidine use may reduce the require-
eISSN: 2395-0471 ment of Propofol and Ketamine, with faster postopera-
pISSN: 2521-0394
ve recovery and more stable intraopera ve haemody-
namics [12].
Correspondence: Dr Rahul Kunkulol, Professor, Department of Pharmacology, Rural Medical College, Loni, Pravara
Institute of Medical Sciences (Deemed University), Maharashtra
International Journal of Clinical and Biomedical Research. © 2017 Sumathi Publications.
This is an Open Access article which permits unrestricted non-commercial use, provided the original work is properly cited. 64
Kunkulol RR et al. Dexmedetomidine premedication with Ketamine and Propofol during burns debridement and dressings
Comparison of Heart Rate (beats/min) at various me Unpaired t test P value, the two-tailed P value is <
intervals heart rate was significantly higher in Group A 0.0001, considered extremely significant. t = 8.287 with
as compared to Group B. There was sta s cally signifi- 58 degrees of freedom. Inference: Less me was re-
quired by Group B for recovery.
cant difference between the groups as per Student t-
test (p<0.05).
followed by Ketamine 1mg/kg and Propofol 1mg/kg at needs less preopera ve monitoring as compared to IV
induc on. Supplements of Ketamine 0.5mg/kg and Dex. Also, Scheinin H et al [21] showed that the intra-
Propofol 0.5mg/kg were given as and when required to muscular doses resulted in linearly dose-related plasma
maintain Ramsay Seda on Score of 5 or more. concentra ons of Dexmedetomidine; henceforth, clear-
In the present study, majority of the pa ents (40%) in ance and half-life remains constant irrespec ve of its
Group A were in the age group of 31-40 years and plasma concentra on. For all these reasons we evaluat-
(46.7%) in Group B were in the age group of 31-40 ed the effect of 1.0 μg/kg IM Dex on the requirement
years No sta s cal difference was found by applying for supplemental Propofol and Ketamine during anes-
Chi-Square test (p>0.05).(Figure no.1) thesia for burns debridement and dressing changes.
The gender distribu on in the two groups as per Fish- Despite the limited data, the advantage of adding Dex-
er’s test were comparable and sta s cally not signifi- medetomidine with Ketamine is that both balance the
cant (p>0.05). 40 % and 39% pa ents were females in haemodynamic and adverse effects of each other. Dex-
Group A and B respec vely (Figure no.2)Ravipa P et al
medetomidine may decrease the incidence of tachycar-
[13] observed there was no sta s cally significant
difference in the demographic and clinical characteris- dia, hypertension, saliva on, and emergence phenome-
cs among the two groups. na from Ketamine, while Ketamine may prevent the
It was observed that intraopera vely the heart rate, bradycardia and hypotension of Dexmedetomidine.
systolic and diastolic Blood pressure was significantly Addi onally, Ketamine as part of the seda on induc on
higher in Group A as compared to Group B. There was may speed the onset of seda on and eliminate the
sta s cally significant difference between the groups slow onset me of IM Dex [22].
as per Student t-test (p<0.05). (Figure no.3, 4, and 5).
The recovery me in Group A was 12.9 mins as com- CONCLUSION
pared to 9.5 mins in Group B. There was sta s cally
significant difference between the groups as per Stu- Dexmedetomidine (1 μg/kg IM dose) is a good anes-
dent t-test (p<0.05). the c adjuvant that decreases the requirement of
Ravipa P et al [13] observed Time to recovery was Propofol and Ketamine during burns debridement and
9.57 ± 1.50 min in the Dex group which was significant- dressings, a enuates sympathoadrenal response,
ly lower than in the control group 11.53 ± 2.56 min (P = maintains stable intraopera ve haemodynamic and
0.0006). (Figure no.6) also has an excellent recovery profile.
It was observed that dose requirement of Ketamine Acknowledgements: We acknowledge all the faculty
(228.8±21.9) and Propofol (263.2 ± 22.5) was signifi- members of the Department of Anesthesia and cri cal
cantly more in Group A as compared to Group B care and Directorate of Research PIMS-DU for their
(101.1±20.3 and 120.8±22.4 respec vely). Sta s cally help and coopera on for this study
significant difference was found by applying Student t-
test (p<0.05). (Figure no.7) Ravipa P et al [13] ob-
Conflict of interest : Nil
served mean dose of Ketamine used in Dex group was
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How to Cite this article: Supr abhat Kir an, Pr ashant Rai, Badhe VK, Kunkulol RR. Dexmedetomidine pr emedication with
Ketamine and Propofol during burns debridement and dressings. Int. j. clin. biomed. res. 2017;3(4): 64-68