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Korean J Anesthesiol > Volume 44(4); 2003 > Article
Korean Journal of Anesthesiology 2003;44(4):452-461.
DOI: https://doi.org/10.4097/kjae.2003.44.4.452   
Hormonal Responses during Propofol-Fentanyl-Ketamine Anesthesia Compared with Propofol-Fentanyl-N2O Anesthesia.
Hee Jung Baik
Department of Anesthesiology, Ewha Medical Research Center, Ewha Womans University, Seoul, Korea. baikhj@mm.ewha.ac.kr
BACKGORUND: The goal was to investigate hormonal responses, propofol dose and hemodynamic responses during propofol-fentanyl-ketamine anesthesia compared with propofol-fentanyl-N2O anesthesia.
Twenty adult female patients undergoing total abdominal hysterectomy under general anesthesia were enrolled. They were randomly divided into 2 groups according to anesthetic agents; propofol-fentanyl-N2O for group PFN and propofol-fentanyl-ketamine for group PFK. Target plasma concentrations of propofol were controlled to maintain a bispectral index between 40 and 60. Hemodynamic and hormonal responses (cortisol, prolactin, growth hormone, insulin and glucose) were measured before induction, pre-intubation (only for hemodynamic responses), 2 min after intubation, 2 min after skin incision, at closure of the peritoneum and 5 min after extubation. Administered dose, plasma and effect site concentration of propofol were also evaluated.
Pre-intubation mean arterial pressure (MAP) in group PFK decreased less than that in group PFN significantly (PFK; 88+/-2.9%, PFN; 78+/-2.9%)(P<0.05). There were no significant differences in the administered dose and plasma concentrations of propofol between the two groups. Hormonal responses showed similar changes in both groups except for significant differences in cortisol (PFK; 78+/-3.1%, PFN; 67+/-2.4%) 2 min after skin incision and in insulin (PFK; 225+/-69.5%, PFN; 103+/-21.6%) and glucose (PFK; 127+/-4.5%, PFN; 110+/-5.7%) 5 min after extubation.
Propofol-fentanyl-ketamine anesthesia can prevent severe decreases in pre-intubation MAP and with respect to hormonal change and required propofol dose, can be a good substitute for propofol-fentanyl-N2O anesthesia.
Key Words: Fentanyl; hemodynamics; hormones; ketamine; nitrous oxide; propofol
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