Bispectral index (BIS) guided comparison of ketamine-propofol or fentanyl-propofol combinations when used in day care urological surgeries

Introduction and Aims: With the increased emphasis on early discharge after surgery, rapid recovery and early ambulation and cost effectiveness, use of short acting drugs like propofol, ketamine and fentanyl along with Bispectral Index (BIS) which allows titration of hypnotic drugs doses and may promote earlier awakening, we conducted this study to explore effectiveness of combinations ketamine-propofol and fentanyl-propofol in day care urological surgery guided by BIS. Materials and Methods: After ethical approval and informed consent 140 patients scheduled for minor urological procedures on day care basis were randomised into two equal groups receiving ketamine-propofol and fentanyl-propofol combinations, to primarily observe haemodynamics, respiratory parameters, optimum sedation guided by BIS and recovery time in terms of Modified Aldrete Score (MAS) and secondarily total propofol consumption and side effects. Results: Patients remained haemodynamically stable in group ketamine-propofol after induction while in group fentanyl-propofol there was significant fall in heart rate up to nine minutes after induction and blood pressure remained significantly low up to fifteen minutes. There was significant fall in respiratory rate and oxygen saturation but significantly early recovery with fentanyl with no significant difference in the incidence of side effects of apnoea, hypotension, bradycardia and nausea-vomiting and hallucination between the groups. Conclusion: Ketamine-propofol combination produces rapid anaesthesia with stable haemodynamics while fentanyl-propofol combination allows faster awakening and reduces the length of stay in the post-anaesthesia recovery room. BIS monitoring optimize intraoperative condition and leads to significantly early recovery for faster home readiness in the ambulatory surgery.