• Yu-Ying Tang, Xue-Mei Lin, Wei Huang, and Xiao-Qing Jiang.
• Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, China. yutingtang@sohu.com
• J Minim Invasive Gynecol. 2010 May 1;17(3):325-30.

Study ObjectiveTo assess the feasibility of propofol-fentanyl sedation protocol with ketamine for gynecologic diagnostic laparoscopy.DesignProspective, double-blind, randomized study (Canadian Task Force classification I).SettingOutpatient operating unit in a university hospital specializing in obstetrics and gynecology.PatientsEighty women who underwent outpatient gynecologic diagnostic laparoscopy.InterventionsPatients were randomly assigned to receive fentanyl, 1 microg/kg, and normal saline solution (group F, n = 40), or fentanyl, 1 microg/kg, and ketamine, 0.5 mg/kg (group FK, n =40), followed by propofol, 2.0 mg/kg, for sedation induction. During surgery, propofol was supplemented to achieve a target Ramsey score of 6, and cardiopulmonary support was required to maintain stable vital signs.Measurements And Main ResultsFive of 40 patients (12.5%) in group FK reported pain associated with propofol injection compared with 33 of 40 patients (82.5%) in group F. During surgery, 7 patients (17.5%) in group FK required rescue propofol compared with 32 patients (80.0%) in group F (p <.001). The mean (SD) rescue dose of propofol was 0.4 (0.5) mg/kg in group FK compared with 1.6 (0.6) mg/kg in group F (p <.001). In group F, 17 patients (42.5%) required assisted mask ventilation because of respiratory depression, and in 21 patients (52.5%), atropine therapy was necessary to treat bradycardia, compared with 6 patients (15.0%) and 11 patients (27.5%), respectively, in group FK (p <.05). The mean arterial blood pressure at the end of induction, pneumoperitoneum inflation, and trocar insertion was significantly decreased in group F compared with group FK (p <.05). No differences were observed between the 2 groups insofar as operation duration, recovery time, discharge time, intraoperative awareness, incidence of postoperative nausea and vomiting, and postoperative pain. Although patient satisfaction scores were comparable, a higher degree of gynecologist satisfaction was observed in group FK compared with group F (p <.001).ConclusionAddition of low-dose ketamine to propofol-fentanyl sedation can provide more stable and satisfactory operation conditions in gynecologic diagnostic laparoscopy.Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.

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