감시하 마취관리 동안 자가 진정 조절을 이용한 Propofol, Propofol-Fentanyl, Propofol-Ketamine 군에서 진정의 질적 효과, 부작용, 회복 양상의 비교

• Published in: Korean journal of anesthesiology Vol. 50; no. 4; pp. 428 - 433
• Main Authors: 최진우, Jin Woo Choi, 주진덕, Jin Deok Joo, 인장혁, Jang Hyeok In, 김용신, Yong Shin Kim, 전연수, Yeon Su Jeon, 유건희, Keon Hee Ryu, 김대우, Dae Woo Kim, 이현탁, Hyen Tac Lee
• Format: Journal Article
• Language: Korean
• Published: 대한마취통증의학회 30.04.2006
• Subjects: MAC; monitored anesthesia care; patient-controlled sedation; PCS; 마취과학
• ISSN: 2005-6419; 2005-7563

Background: Propofol has been the most widely used IV adjuvant during Monitored anesthesia care (MAC), even though it lacksanalgesic properties. This study was designed to compare sedation quality, side effects, and recovery profiles of propofol alone (group P), propofol-fentanyl (group PF) and propofol-ketamine (group PK) using PCS for breast biopsy procedures using local anesthesia. Methods: Anxiety VAS, pain VAS and digit symbol substitution test (DSST) were measured in 60 excision breast biopsy patients with local anesthesia. Vital signs, respiratory (SpO2, RR, and ETCO2) variables, BIS, and OAA/S scores were recorded. Perioperative side effects (e. g., pain on injection, excessive sedation [OAA/S ＜ 4], hypoventilation [ventilatory frequency 8 bpm], hypotension, dizziness, unpleasant feeling, Nausea) were also noted. Results: There were no differences among the three PCS groups with respect to demographic data (Table 1). A/D ratio in PK group had a significant increase over P group. The incidence of excessive sedation and dizziness were significantly more frequent in the PK group patients (P ＜ 0.05)(Table 1, 2). OAA/S scores were significantly decreased in the PK group during near the end of surgery, whereas BIS scores were only at the end of surgery (P ＜ 0.05)(Fig. 1, 2). During 15 min after arrival at recovery room, significantly less patients in the PK group gave correct responses on the DSST than other groups (P ＜ 0.05)(Fig. 2, 3). Conclusions: In contrast to past studies of ketamine as an alternative to opioid adjuncts during propofol PCS, it has no more advantage than supplemental fentanyl in terms of sedation level and side effects. (Korean J Anesthesiol 2006; 50: 428~33)