Comparative Evaluation of Vital Signs Stability, Sedation and Analgesia Scores with Two Methods of Sedation: Propofol+Fentanyl and Ketamine+Fentanyl during Perm Cath Insertion

Abstract The aim of this study was comparison of sedation and analgesia between two drug combinations i.e. propofol+ fentanyl and ketamine+fentanyl, in patients with End stage renal disease, (ESRD) who were candidates for insertion of ‘Perm Cath’ catheter for the purpose of hemodialysis. Fifty one candidates for ‘perm cath’ catheter insertion were enrolled in this study. They were divided into three groups: Propofol+fentanyl; ketamine+fentanyl, and placebo. Systolic and diastolic blood pressure, heart rate and respiratory rate were measured before the procedure and then every 5 minute until the end of the procedure. Xylocaine was infiltrated at the site of insertion in all groups. Propofol1mg/kg with fentanyl 1micgr/kg were injected in propofol group, and ketamine 0.5mg/kg with fentanyl 1micgr/kg in the ketamine group. Pain was measured with Ambesh score in the beginning of catheter insertion and sedation was measured with Ramsay score at the beginning of procedure and at insertion of catheter in the heart. Patient satisfaction was measured qualitatively in the PACU. Comparative evaluation of mean heart rate, mean systolic and diastolic blood pressure and mean respiratory rate were different among the three groups, (P<0.05).Frequency distribution of pain was different among groups in the beginning of the procedures (P=0.001); also sedation score was different in the beginning of the procedures and when the catheter entered the heart among the three groups (P<0.001). Patients satisfaction score was higher in propofol group, (P=0.001). Local infiltration of Xylocaine at Perm Cath insertion is insufficient to produce sedation and analgesia, and it is necessary to use sedative drugs in combination. Both methods of sedation: propofol+fentanyl and ketamine+fentanyl provide sedation and analgesia effectively. Propofol appears to be superior in providing stability of vital signs, sedation and patient satisfaction. KEYWORDS: Perm Cath, ESRD, Sedation, Propofol, Ketamine, Monitoring anesthesia care.