Vol. 6, Issue 2, Part A (2024)

Introduction: The global economic constraints and increasing financial awareness of 1970s led to the increase in the incidence of ambulatory surgery. A backup emergency care, either at same place or at a nearby hospital, must be available. But for the successful conduct of anaesthesia, careful patient selection, type of surgeries based on the facilities available, appropriate preparation of patient and planning are essential. Fentanyl is a popular anaesthetic because of its relatively short time to peak analgesic effect, rapid termination of effect, and has cardiovascular safety.

Objective: To assess the Ketamine v/s Fentanyl a comparative study- in short surgical procedures.

Methods: This is a prospective, comparative, and interventional study was conducted at Department of Anaesthesiology, 250 Beded General Hospital, Lalmonirhat, Rangpur, Bangladesh from July to December 2023. 50 patients were randomly allocated into two groups. 25 patients in group K received Ketamine inj i.v and 25 patients in group F received Fentanyl inj. i.v. preoperatively. Hemodynamic parameters like Pulse, systolic BP (SBP), Diastolic BP (DBP), respiratory rate (RR) and peripheral oxygen saturation (SPO2) monitored pre, intra and post operatively. Recovery parameters like, Visual Analog Score, (VAS score), orientation, first analgesic dose (FAD) and spontaneous eye opening (SEO) were noted. Postoperative complications like nausea, vomiting, salivation, and excitation were observed for. Statistically the data was analysed.

Results: Total 50 patients aged 20-60 yrs of ASA grade I & II posted electively for short surgical procedures of 20-30 duration were included in the study. 25 patients received ketamine 1 mg/kg iv (Group K) and other 25 received Fentanyl 1 μg/kg iv (Group F) iv for induction and maintenance. The number of patients in Group K in the age group of 21-30 yrs was 5(20%), in 31-40 yrs was 8(28%), in 41-50 yrs 10(40%), in 51-60 yrs was 3 (12%) as compared to 6(24%), 8(32%), 6(24%), and 5(20%) respectively in Group F. Demographic data of both the groups were similar for mean age, weight and sex ratio. There was no significant difference in duration of procedure. The mean weight in group K was 56.67±5.97 kg as compared to 53.30±5.88 kg in group F, difference being statistically Nil significant (P=0.127). All continuous variables were presented by mean±standard deviation using Z test. But age and sex were presented by frequency and percentage. P value of <0.01 was considered statistically highly significant. Ketamine was found to offer advantages of better hemodynamic stability, prolonged postoperative analgesia, and without any significant post-operative complications like, nausea and vomiting or emergence reactions. Patient compliance was better with patients in group K, as only sub- anaesthetic doses were used. With this dose, hallucinations, unwanted involuntary movements and emergence delirium were not seen.

Conclusion: Ketamine and fentanyl in Day care anesthesia in short surgical procedures, ketamine was found to offer advantages of better hemodynamic stability, prolonged postoperative analgesia, and without any significant post-operative complications like, nausea and vomiting or emergence reactions. Ketamine was found to be more hemodynamically stable than fentanyl. When used in low doses it caused least complications and patient compliance was good. Cost-effectiveness was also better.