Comparision of dexmedetomidine and propofol in patients undergoing laparoscopic cholecystectomy under spinal anesthesia

Background: Spinal anesthesia (SA) with sedation is considered to be an alternative to general anesthesia for laparoscopic cholecystectomy (LC) in high-risk patients. Ketamine in analgesic dose with propofol or dexmedetomidine infusion provides titratable sedation, hemodynamic stability, and minimum respiratory depression without psychomimetic effects. Aim: To compare the efficacy of ketamine–dexmedetomidine and ketamine-propofol combination in relation to sedation, analgesia, hemodynamic effects, and perioperative side effects. Settings and Design: This was a prospective, randomized single-blind comparative study comprising 100 American Society of Anesthesiologists I, II, and III patients posted for LC. Materials and Methods: Patients were randomized into two groups of 50 patients each. Group KP (ketamine + propofol) received intravenous (i.v.) bolus of injection ketamine 0.5 mg.kg−1 and propofol infusion at 3 mg.kg−1.h−1. Group KD (ketamine + dexmedetomidine) received i.v. bolus of injection ketamine 0.5 mg.kg−1 and dexmedetomidine infusion at 0.4 μg.kg−1.h−1. Parameters observed were vitals, perioperative side effects, time to first rescue analgesia, and return of consciousness. Statistical Analysis: Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables. Results: Duration of analgesia was longer in KD Group (191.2 vs. 173.5 min), and time to regain consciousness was faster in KP Group (14.9 vs. 20.4 min). Conclusion: Both the techniques of sedation are feasible, safe, and comparable, except the duration of analgesia and time to regain consciousness which was longer in KD Group.