(1438) Comparing the Dose of Propofol on Combining With Ketamine Versus Fentanyl in Patients on Ventilator

Introduction: Propofol along with fentanyl is a frequently used sedative in the ICU, but it is commonly associated with a side effect like hypotension. A study was planned to evaluate whether use of ketamine as an adjunct prevents the side effects.

Methods: Total 100 patients who expected to be on mechanical ventilation for at least 48 hours were enrolled in the study. The participants were randomized into two groups: Propofol-Fentanyl and Propofol-Ketamine for analgo-sedation. The propofol doses were titrated in both groups to target sedation score of 0 to -2 (RASS). The fentanyl was administered at the fixed dose of 1 mcg/kg/hr and the ketamine was administered at 2 μg/kg/min for the first 24 hours and 1 μg/kg/min for the next 24 hours. The dose of propofol and the norepinephrine needed was evaluated. The anti-inflammatory effects of the drugs in both the groups were also compared.

Results: The doses of propofol received in the ketamine group were (mean-11.65 μg/kg/min, IQR-8.71 μg/kg/min to 13.55 μg/kg/min) significantly higher than those in the fentanyl group (mean-9.5 μg/kg/min, IQR-8.46 μg/kg/min to 10.68 μg/kg/min) with small to moderate effect size. The TNF-α levels were lower (mean-81.334 pg/ml at baseline to 31.969 pg/ml after 48 hours) in the ketamine group as compared to fentanyl group (mean-86.516 pg/ml at baseline to 50.204 pg/ml after 48 hours). The dose of norepinephrine needed to keep MAP≥65 mm of Hg in the shock patients was not significantly different between the groups.

Conclusions: The dose of propofol needed to target light sedation (RASS 0 to -2) in ICU patients is higher in patients who received ketamine infusion than the fentanyl group. The clinical significance of this small to moderate increase in the propofol dose is not known. The ketamine infusion decreased the production of TNF-α. There is no significant difference between the groups in terms of residual effects of sedation measured by the time taken to start analgesic and sedative agent after stopping the trial drugs and the time taken for extubation after stopping the trial drugs. The dose of nor epinephrine infusion needed to target MAP≥65 mm Hg in shock patients also didn’t differ significantly between the groups.