Comparison of ketamine and dexmedetomidine in maintaining hemodynamic stability in laparoscopic cholecystectomy surgery with general anesthesia : a double-blind randomized clinical trial study

Document Type : Original Article

Authors
mojtaba ghaedi 1
sadegh saneia 2
Reza Sahraei 2
lohrasb taheri 3
niloofar razmavar 4
1 Department of Surgery, Jahrom University of Medical Sciences, Jahrom, Iran.
2 Associate Professor, Anesthesia Department, Anesthesia and Pain Control Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
3 Department of Surgery, Jahrom University of Medical Sciences, Jahrom, Iran
4 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
10.22034/pjms.2023.705061
Abstract
Introduction: One of the basic features of a successful anesthesia is reversible loss of consciousness with immobility, lack of awareness, not responding to painful stimulation and not remembering surgical interventions. The present study was conducted with the aim of comparing ketamine and dexmedetomidine in maintaining hemodynamic stability in laparoscopic head cystectomy surgery with general anesthesia.
Materials and Methods: This study is a double-blind randomized clinical trial Study. 90 patients aged 18 to 44 (in three groups of 30) were evaluated during general anesthesia. Inclusion criteria included anesthesia class (ASA I, II) and consent to participate in the study. Patients were randomly divided into three groups: 1) control and 2) intervention with ketamine, intervention and 3) intervention with dexmedetomidine. Patients' hemodynamic symptoms (systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood oxygen saturation percentage and heart rate) were evaluated. Data analysis was done using descriptive statistics (mean, percentage and standard deviation) and inferential statistical tests (Mann-Whitney and Kruskal-Wallis) using SPSS version 21 software. 
Results: The findings of the research showed that between the three groups of ketamine, dexmedetomidine and control in the times before induction, after induction, 5 minutes after, 15 minutes after, 30 minutes after, 60 minutes after, in recovery and outside of recovery, from There was a significant difference in mean systolic and diastolic blood pressure and mean arterial blood pressure (P<0.05). But there was no significant difference in heart rate between the three groups at these times (P<0.05). The average percentage of blood oxygen saturation in the ketamine group was lower than the dexmedetomidine and control groups (P<0.05).
Conclusion: Based on the results of the present study, the use of dexmedetomidine in laparoscopic cholecystectomy surgery compared to ketamine causes hemodynamic stability in laparoscopic cholecystectomy surgery with general anesthesia.
Keywords
Ketamine
Dexmedetomidine
Hemodynamics
Cholecystectomy
General anesthesia
1. Alkire MT, Hudetz AG, Tononi G. Consciousnessand anesthesia. Science. 2008; 322(5903):876-80.2. Manuel C, Pardo Jr.Basics of Anesth. Elsevier; 213.3. Bernstein K, Gisselsson L, Jacobsson L, Ohrlander S.InfluenceofTwoDifferentAnaesthetic Agents on theNewborn and the Correlation between FoetalOxygenation and Induction‐Deliveryime in ElectiveCaesarean Section. AAC. 1985; 29(2):157-60.4. Ganning M, Perkins Z , Queenn T. Trenchentrapment: is ketaminesafe to use for sedation inhead injury. EMJ. 2007; 24: 794-95.907965. Menigaux C, Fletcher D , Dupont X. The benefits ofntraoperative small-dose ketamine on postoperativepain after anterior cruciate ligament repair. AnesthAnalg. 2000; 90: 129-35.
6. Guillou N, Tanguy M , Seguin P. The effect of smalldose ketamine on morphine consumption in surgicalintensive care unit patient after major abdominalsurgery. Anesth Analg. 2003; 97: 843-7.7. Lahtinen P, Kokki H, Hakala T and markku H. S(+)-ketamine as an analgesic adjunct reduces opioidconsumption after cardiac surgery. Anesth Analg.2004; 99:1295-1301.8. Ghodraty M, Pournajafian A, Rokhtabnak F, Feiz HAzhdarkosh H, Allame S. Evaluation of intranasal
dexmedetomidine in providing moderate sedation inpatients undergoing ERCP: A randomized controlledtrial. JMUMS. 2016; 26(143):11-9.9. Bajwa S, Kulshrestha A. Dexmedetomidine: Anadjuvant making large inroads into clinical practice.
Ann Med Health Sci Res. 2013; 3(4): 475-483.10. Belleville JP, Ward DS, BloorBC,MazeMEffectsofintravenousdexmedetomidine in humans. I.Sedation, ventilation, and metabolic rateAnesthesiology. 1992;77(6):1125-1133.11. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2adrenergic agonists to prevent Perioperativecardiovascular complications: A meta-analysis. Am JMed. 2003; 114(9): 742-752.12. Aantaa R, Schienin M. Alpha 2-adrenergic agents inanesthesia. AAC. 1993; 37(5): 433-448.13. Coursin DB, Maccioli GA.Dexmedetomidine. CurrOpin Crit Care. 2001; 7(4): 221-226.14. Anttila M, Penttilä J, Helminen A, Vuorilehto L,
Scheinin H. Bioavailability of dexmedetomidine afterextravascular doses in healthy subjects. BJCP. 2003;56(6):691-3.
15. Young CC, Prielipp RC. Sedative analgesic, andneuromuscular blocking drugs. In: Critical CareMedicine: Perioperative Management, Murray MJ,Coursin DB, Pearl RG et al. 2thed. New York:Lippincott Williams & Wilkins; 2002. P. 147-167.16. Demiraran Y, Korkut E, Tamer A, Yorulmaz I,Kocaman B, Sezen G, Akcan Y. The comparison ofdexmedetomidine and midazolam used for sedation ofpatients during upper endoscopy: A prospective,randomized study. CJGH. 2007;21(1):25-9.17. Al-Waili N, Saloom KY. The analgesic effect ofintravenous tenoxicam in the symptomatic treatment
of biliary colic. Eur J Med Res. 1998;14:475–9.18.Nazemroaya B, Honarmand A, Bab Hadi Ashar M.Effects of adding dexmedetomidine o ketamine onheart rate and blood pressure changs in psychiatricpatientsundergoingelectroconvulsive therapy.Koomesh. 2020; 22 (2) :311-31619. Kamel GF, Ali RM, Ismail AE, Hanna BE.Comparative evaluation of hemodynamic stability andrecovery during conscious sedation bydexmedetomidine with fentanyl versus ketamine withfentanyl in dilatation and curettage. Egy J Hosp Med.2018; 73: 5992 - 599720. Tarek FT. Comparison of the efficacy ofdexmedetomidine, ketamine, and a mixture of both forpediatric MRI sedation. EGJA. 2013; 29(3): 241-46
21. Owens VF, Palmieri TL, Comroe CM, Conroy JM,Scavone JA, Greenhalgh DG. Ketamine: a safe andeffective agent for painful procedures in the pediatricburn patient. J Burn Care Res. 2006; 27:211–6.22. Walker J, Maccallum M, Fischer C, Kopcha R,Saylors R, McCall J. Sedation using dexmedetomidinein pediatric burn patients. J Burn Care Res. 2006;
27:206–10