A0024 Effect of Combination of Ketamine and Propofol (Ketofol) on Cerebral Oxygenation Using SjVO₂ as Parameter in Neurosurgical Patients: A Randomized Double-Blind Control Trial

Background: The effects of ketofol on several parameters such as hemodynamics and requirement of opioids/propofol have been published. But data on effects of ketofol on cerebral oxygenation are inadequate. This study aims to compare the effects of ketofol (ketamine:propofol = 1:5) with propofol on cerebral oxygenation (jugular venous oxygen saturation [SjVO₂]), in patients undergoing surgical clipping of intracranial aneurysm.

Materials and Methods: Forty WFNS I and II patients were randomized into ketofol (n = 20) and propofol (n =20) groups. Post-induction SjVO₂ catheter was inserted, and anesthesia was maintained with propofol/fentanyl in propofol group and ketofol/fentanyl in the ketofol group. SjVO₂ was obtained at baseline, 1 hour and 2 hours intraoperatively and at 6 hours after the surgery. Also, intraoperative brain relaxation, fentanyl requirement, and hemodynamics were noted.

Results: Higher SjVO₂ values were observed in ketofol group compared with propofol at 1 and 2 hours after starting the drug and at 6 hours after surgery (p < 0.05). In propofol group, a significant fall in SjVO₂ was recorded at 2 hours (during temporary clipping) after the starting of drug as compared with the baseline (p = 0.001). All recordings of SjVO₂ in both the groups were within normal limits. Requirement of fentanyl in ketofol group was less as compared with propofol group (p = 0.022). More than 20% fall in mean arterial pressure (MAP) compared with baseline MAP was noted in 75% of patients in propofol group and 15% of patients in ketofol group (p = 0.002). In propofol group, 55% patients required rescue drug phenylephrine to treat hypotension, whereas only 15% patients required it in ketofol group (p = 0.02). Brain relaxation score was comparable in both the study groups (p = 0.887).

Conclusions: Maintenance of anesthesia with ketofol provides better cerebral oxygenation and hemodynamic stability compared with propofol in patients undergoing clipping of cerebral aneurysm after SAH.