Effects of ketamine, clonidine and their combination on hemodynamic parameters and post-operative outcomes
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Effects of ketamine, clonidine and their combination on hemodynamic parameters and post-operative outcomes
- 1. Submitted BY: Ashish Ranjan Anirban Ghosh Ayan Das Madhumita Ghosh Somdeep Sen
- 2. Total: 120 Patients Group K=30 Group C=30 Group KC=30 Group P=30 Intravenous ketamine Intravenous clonidine Intravenous ketamine & clonidine Normal saline Objectives: To compare HR, SBP, DBP, MAP, SPO2 & ETCO2 across groups -In intra-op & Post-op stages at different time intervals -From the base line (Pre-op: for Intra-op & EOC: for Post-op) To study (across groups) - Adverse events (Tachycardia, Bradycardia, Hypertension, Hypotension & Nausea Vomiting) - Shivering and sedation
- 3. Demographic Details AGE WEIGHT Mean 42.70 39.80 K 73.93 64.70 43.27 40.07 C 161.70 77.23 64.10 74.27 61.47 76.63 DOS 163.37 163.07 161.47 64.70 HEIGHT KC P Groups Differences in age, height, weight, DOS and sex across groups: statistically insignificant
- 4. Parameters(mean) Results Statistically difference across groups except the preoperative state Heart Rate Patterns are same for group K, KC and P Mean heart rate of group C is relatively lower SBP DBP MAP Statistically difference across groups except the preoperative state Similar pattern as the HR Statistically difference across groups except the preoperative state Similar pattern as SBP & HR Statistically difference across groups except the preoperative state Similar pattern as SBP , HR & MAP SPO2 Statistically insignificant difference across groups ETCO2 Similar pattern as SP02 ST Similar pattern as SP02 & ETCO2 Statistically significant difference across groups at all stages CT Results are similar for group K, C & KC No fluctuations in results (36.53) for group C at all stages
- 5. Parameters(mean) Results Statistically significant difference across groups at all stages HR Identical results in group KC & P Results are relatively similar in Group K, KC & P Values for group C is relatively lower Statistically significant difference across groups at all stages SBP Results are relatively similar in Group K, KC & P Values for group C is relatively lower DBP Similar patterns as SBP Statistically significant difference across groups at all stages MAP Results are relatively similar in Group K, C & KC Values for group P is relatively lower SPO2 Statistically insignificant difference across groups at all stages
- 6. Groups Results HR, MAP, ST, DBP is different throughout K ETCO2, SPO2 is stable throughout Mean SBP is stable except intubation and end of surgery CT is different across all time intervals except the first 5 minutes HR, SBP is different throughout except IND C SP02, ETCO2 is same throughout CT is different across all time intervals except the first 5 minutes ST, DBP is different throughout HR, ST is different throughout KC SBP, MAP, DBP, SP02, ETCO2 is stable throughout CT is different across all time intervals except the first 5 minutes MAP, DBP, SPO2, ETCO2, CT is stable throughout P Mean Heart is same throughout except IND Mean SBP is stable except EOS ST is different across all time intervals * Parameters are expressed as mean
- 7. Groups K C Analysis HR, MAP, SBP, DBP is different throughout SPO2 is stable throughout HR, MAP, SBP, DBP is different throughout SPO2 is stable throughout HR, DBP, is different throughout KC SBP & SPO2 is stable throughout Mean MAP is different except 5 & 10 minutes interval P HR, MAP, SBP, DBP is different throughout SPO2 is stable throughout * Parameters are expressed as mean
- 8. Adverse Effect(%) 16 15 13.33 14 13.33 12.5 11.67 12 10 8.33 8 6.67 6 5 5 4.17 4.17 4.17 3.33 3.33 4 2.5 2.5 1.67 2 0.83 0.83 0 Bradycardia Tachycardia Hypertension K C KC Hypotension Nausea and Vomiting P Statistically significant difference in the occurrence of adverse events across all the groups
- 9. Events Bradycardia Analysis 27% :out of 120 50 %: out of 30 in group C Relatively low in the other groups Tachycardia 30.83% : out of 120 60 % : out of 30 in group K Relatively low in other groups Hypotension 21.67% : Out of 120 53.3% : Out of 30 in group C None group K has Relatively low in KC and P Nausea & Vomiting Only 12.5% : 120 26% : out of 30 in Group C Relatively low in all the groups. Hypertension 30.83% : out of 120 53 % : out of 30 in group K; 47% of the people (out of 30) in group P Relatively low in group C & KC
- 10. Sedation Score: Within Groups K 100 100 C KC P 100 76.67 23.33 >3 >=3 Statistically significant difference among in the sedation scores across groups All the patients had sedation across groups None belonging to group K, KC and P had extreme sedation(>=3) 23.3%: out of 30 in group C had extreme sedation
- 11. Shivering Score(%): With in Groups K C KC P 66.67 66.67 60.00 50.0 36.67 33.3 30.00 23.33 13.33 10.0 6.67 3.3 0 <3 >=3 Statistically significant difference in the occurrence of shivering across group 75.9% of people: out of 120 27.5% of people had extreme shivering(>=3) 66.67% people out of 30 in group P had experienced extreme shivering Moderate or No Shivering: 86.67% in group KC; 76.67% in Group K and 93.3% in group C Intravenous clonidine: Most useful in prevention of post anesthetic shivering as compared to other drugs Placebo seems to be the least effective in the prevention of shivering in comparison to others
- 12. Terms Abbreviation HR Heart Rate SBP Systolic Blood Pressure DBP Diastolic Blood Pressure MAP Mean Arterial Pressure SPO2 Peripheral oxygen saturation ETCO2 Capnography CT Core Temperature ST Surface Temperature DOS Duration of Surgery Adverse events: •Tachycardia happens when intra-operative Heart Rate rises above 100 •Bradycardia happens when intra-operative Heart Rate falls below 60 •Hypertension happens when the Intra-operative MAP rises 20% or more from Baseline level •Hypotension happens when the Intra-operative MAP falls 20% or more from Baseline level
- 13. Score 0 Shivering Sedation None - peripheral vasoconstriction but no visible 1 fully awake and oriented shivering Muscular activity in only one muscle 2 Drowsy group Muscular activity in more than one 3 Eye closed but responds to commands muscle group but not generalized 4 5 Shivering all over the body - Eye closed but responds to mild physical stimulation. Eye closed and not responding to mild physical stimulation.