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Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction

Published online by Cambridge University Press:  13 April 2005

I. Özkoçak ,
H. Altunkaya ,
Y. Özer ,
H. Ayoğlu ,
C. B. Demırel  and
E. Çıçek
I. Özkoçak
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
H. Altunkaya
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
Y. Özer
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
H. Ayoğlu
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
C. B. Demırel
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
E. Çıçek
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey
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Extract

Summary

Background and objective: This prospective, double-blind, randomized, placebo-controlled study compares the effects of ephedrine and ketamine on injection pain, and hypotension from propofol.

Methods: After obtaining the approval of the Ethics Commitee, 75 patients (ASA I–II) scheduled for elective operations with general anaesthesia were divided into three groups. Saline 2 mL (Group S, n = 25), ketamine 0.5 mg kg−1 (Group K, n = 25) or ephedrine 70 μg kg−1 (Group E, n = 25) were administered over 5 s after tourniquet application. After releasing the tourniquet, propofol 2 mg kg−1 was injected in 30 s. Pain was evaluated on a numerical scale (0–10) where 0 represented no pain and 10 the most severe pain possible. Systolic, diastolic blood pressures and heart rates were recorded preoperatively, 1 min after propofol injection, before intubation and 1, 2 and 3 min after intubation in all patients.

Results: The incidences of pain in Groups S, E and K were similar (84%, 80% and 72%, respectively). The mean pain score in Group K (2.1, SD 3.1) was significantly lower than those of Groups S and E (4.9, SD 2.6 and 4.6, SD 3.3, respectively) (P < 0.05). The systolic and diastolic blood pressure values in Group K (120 ± 27 mmHg) and Group E (123 ± 21 mmHg) before intubation were significantly higher than that of Group S (104 ± 25 mmHg) (P < 0.05). There was no significant difference between the mean heart rate values of the groups.

Conclusions: Low dose ketamine or ephedrine pretreatment may prevent hypotension due to propofol induction. Despite the reduction in injection pain intensity after ketamine, the study drugs were found to be ineffective in lowering the injection pain incidence.

Keywords

ANAESTHETICS, INTRAVENOUS, ketamine, propofolSYMPATHOMIMETICS, ephedrineHYPOTENSION, PAIN MEASUREMENT, INJECTIONS, intravenousRANDOMIZED CONTROLLED TRIAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 1 , January 2005 , pp. 44 - 48
Copyright
© 2005 European Society of Anaesthesiology

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References

Morgan EG, Mikhail MS, Murray MJ. Clinical Anesthesiology, 3rd edn. New York, USA: The McGraw and Hill Companies, 2002: 173.
Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998; 53: 468–476.Google Scholar
Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–969.Google Scholar
Roehm KD, Piper SN, Maleck WH, Boldt J. Prevention of propofol-induced injection pain by remifentanil: a placebo-controlled comparison with lidocaine. Anaesthesia 2003; 58: 165–170.Google Scholar
Durrani Z, Winnie AP, Zsigmond EK, Burnett ML. Ketamine for intravenous regional anesthesia. Anesth Analg 1989; 68: 328–332.Google Scholar
Suzuki S, Masamune T, Nonaka A, Kumazawa T. Pretreatment with ketamine reduces incidence and severity of pain. Masui 2002; 51: 140–143.Google Scholar
Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia 1998; 53: 302–305.Google Scholar
Besler M, Bilginer N, Ersin Y, Sağiroğlu E, Sarar S, Çelik M. A comparison of the efficacy of different pretreatment drugs in resolving the injection pain of propofol. Türk Anest Der Dergisi 2000; 28: 404–408.Google Scholar
Cheong MA, Kim KS, Choi WJ. Ephedrine reduces the pain from propofol injection. Anesth Analg 2002; 95: 1293–1296.Google Scholar
Tekol Y, Tercan E, Esmaoğlu A. Ephedrine enhances analgesic effect of morphine. Acta Anaesthesiol Scand 1994; 38: 396–397.Google Scholar
Gordon NC, Heller PH, Levine JD. Lack of effect of ephedrine on opiate analgesia. Pain 1991; 47: 21–23.Google Scholar
Briggs LP, White M. The effects of premedication on anaesthesia with propofol (Diprivan). Postgrad Med J 1985; 61 (Suppl 3): 35–37.Google Scholar
Gear RW, Miaskowski C, Heller PH, Paul SM, Gordon NC, Levine JD. Benzodiazepine mediated antagonism of opioid analgesia. Pain 1997; 71: 25–29.Google Scholar
Furuya A, Matsukawa T, Ozaki M, Nishiyama T, Kume M, Kumazawa T. Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol. Eur J Anaesthesiol 2001; 18: 88–92.Google Scholar