The Effects of a Subhypnotic Dose of Ketamine on Neuromuscular Block Characteristics of Rocuronium and Intubation Quality


Abdusoglu M. N., Ozkocak I., YURTLU B. S., HANCI V., OKYAY R. D., AYOĞLU H.

TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, vol.32, no.2, pp.399-406, 2012 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 2
  • Publication Date: 2012
  • Doi Number: 10.5336/medsci.2011-24028
  • Journal Name: TURKIYE KLINIKLERI TIP BILIMLERI DERGISI
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.399-406
  • Keywords: Ketamine, propofol, rocuronium, ANESTHESIA, INDUCTION, PROPOFOL, PANCURONIUM, ETOMIDATE, EPHEDRINE, ONSET, TIME
  • Dokuz Eylül University Affiliated: Yes

Abstract

Objective: In this study, we aimed to examine the effects of a subhypnotic dose of ketamine on the neuromuscular block characteristics of rocuronium and intubation quality. Material and Methods: Sixty patients in ASA I-II risk group were included in the study. Group S received 5 mL of 0.9% saline and Group K received 0.5 mg.kg(-1) ketamine in 5 mL volume, one minute before induction. Both groups had anesthesia induction with a propofol dose of 2.5 mg.kg(-1) (Propofol 1%, Fresenius Kabi). This was considered as anesthesia start time. After 1 min, a control single twitch stimulus (0.1 Hz) was applied and recorded. All patients were given 0.6 mg.kg(-1) rocuronium (Esmeron (R) 50 mg.5 ml(-1) N.V. Organon, Oss, Holland) in 5 sec. When the single twitch response was depressed 100%, the patient was intubated and the full depression time (onset time) was noted. Anesthesia maintenance was achieved with O-2/N2O and sevoflurane. Following the intubation, the application of train-of - four (TOF) stimulation was started. When the TOF ratio reached to 20%, rocuronium was repeated at a dose of 0.2 mg.kg(-1). Clinical duration (T25), recovery index (T25-75) and spontaneous recovery time to TOF > 0.9 were recorded. Intubation conditions were assessed by using the scale of Fuchs-Buder. The additional drugs used during the operation and neuromuscular blocker amounts were recorded. The hemodynamic values of both groups were recorded throughout the study. Postoperative recovery times, visual analogue pain scores (VAS) and Ramsay sedation scores were also recorded. Results: The time for 100% depression of single twitch in Group K was shorter than that of Group S (p<0.05). The clinical duration, recovery index and spontaneous recovery duration of the first dose of rocuronium were longer in Group K compared to Group S (p<0.05). There was no difference between the total neuromuscular blocker amounts of the study groups. There was no significant difference between the groups according to intubation scores (p>0.05), recovery times (p>0.05), VAS scores, Ramsay sedation scores or mean arterial pressure values. When the mean heart rate values of the groups were compared, all values of Group K were higher than those of Group S except control and 60th min values (p<0.001). Conclusion: According to our findings, ketamine in a subhypnotic dose shortens the onset time of rocuronium block and extends the clinical duration of first dose of rocuronium without improving the intubation quality.