Comparison of Intraoperative Propofol-Dexmedetomidine and Ketofol-Dexmedetomidine Infusions on Recovery from Anesthesia in Patients Undergoing Endoscopic Transsphenoidal Pituitary Surgeries: A Randomized Controlled Trial.

Abstract

A rapid and smooth emergence is essential in patients undergoing transsphenoidal pituitary surgeries. Ketofol has been used as an anesthetic agent with good recovery characteristics. We conducted this study to compare the recovery profile of the patients receiving propofol-dexmedetomidine or ketofol-dexmedetomidine infusions for transsphenoidal excision of pituitary tumors. Forty adult patients undergoing endoscopic pituitary surgery received either an infusion of propofol (Group P) or ketofol, 1:5 (Group KP) at 0.6-0.9 ml/kg/h. Dexmedetomidine (0.5 μg/kg/h) was administered in both groups. Our aim was to assess the recovery time, extubation time, and emergence time. We also assessed the intraoperative hemodynamics, cerebral oxygenation, quality of the surgical field, and postoperative pain. The recovery time (Group KP v/s P; 16.5 ± 4.3 vs 8.3 ± 2.7 minutes, P < 0.01), emergence time (12.9 ± 3.9 vs 5.7 ± 2.7 minutes, P < 0.01), and extubation time (14.3 ± 4.2 vs 7.2 ± 2.8 minutes, P < 0.01) were longer in Group KP as compared to Group P. However, the patients in Group KP had lower cough scores and pain scores, along with better maintenance of hemodynamic stability and cerebral oxygenation. The agitation score, cognition score, and quality of the surgical field were comparable. The use of ketofol resulted in a longer recovery time compared to the use of propofol alone. However, ketofol was associated with a better quality of extubation, maintenance of hemodynamic stability, and enhanced postoperative analgesia. Further research is needed to conclusively establish its efficacy and optimal dosage in pituitary surgery.