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Background and Objectives: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture., Method: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method., Results: In propofol, studied strains grew from 10(3)-10(4) cfu/mL to ≥10(5) cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 μg/mL; S.aureus 19.5, 156 μg/mL; P.aeruginosa 312.5, 625 μg/mL; and C.albicans 156, 156 μg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 μg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 μg/mL)., Conclusion: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture., (Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

The aim of this study was to evaluate the effect of a ketamine:propofol combination ('ketofol') for electroconvulsive therapy on seizure activity, haemodynamic response and recovery parameters, and to compare with these with the effects of propofol alone. Twenty-four patients underwent a total of 144 electroconvulsive therapy sessions, allocated in this prospective, double-blind, crossover study. Patients were randomly assigned to receive 1 mg/kg ketofol (0.5 mg/kg propofol plus 0.5 mg/kg ketamine) or 1 mg/kg propofol 1% for anaesthesia induction. Seizure duration and quality, haemodynamic data, recovery parameters and side-effects were recorded and analysed between groups. Both motor and electroencephalography seizure durations in the ketofol group (29 ± 17 and 41 ± 17 seconds, respectively) were similar to that in the propofol group (28 ± 13 and 38 ± 16 seconds, respectively). Postictal suppression index was higher in the ketofol group (89.63 ± 7.88) than in the propofol group (79.74 ± 14.6) (P <0.05). In the ketofol group, heart rate after the seizure ended and mean arterial pressures, recorded at 0 and 5 minutes after the seizure ended, were higher than in the propofol group. Time to obeying commands was longer in the ketofol group (P <0.05). There were no untoward psychological reactions following ketofol. Although no superiority to propofol in terms of seizure duration, haemodynamic or recovery parameters was found, the ketofol mixture selected in our study provided better seizure quality than propofol. We conclude that ketofol can be an alternative strategy to enhance the seizure quality and clinical efficiency of electroconvulsive therapy.

Background and Objective: Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability., Methods: We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5mgkg(-1), remifentanil 3microgkg(-1) and propofol 3mgkg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SpO(2) were recorded., Results: The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05)., Conclusion: The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses.

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway (PLMA) insertion conditions in children. Eighty children, aged between 3-132 months, were randomly allocated to receive either alfentanil 20 microg.kg(-1) (alfentanil group) or ketamine 0.5 mg.kg(-1) (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg(-1), a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg(-1) with propofol 4 mg.kg(-1) preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 microg.kg(-1) during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil.

The article discusses a study of the administration of Ketofol, a mixture of ketamine and propofol, in patients referred to electroconvulsive therapy. The researchers analyzed the seizure activity, hemodynamic response and recovery parameters in the 25 patients included in the study. They found similar motor and electroencephalography seizure durations in both the ketofol and propofol groups.

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway® (PLMA) insertion conditions in children. Eighty children, aged between 3–132 months, were randomly allocated to receive either alfentanil 20 μg.kg−1 (alfentanil group) or ketamine 0.5 mg.kg−1 (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg−1, a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg−1 with propofol 4 mg.kg−1 preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 μg.kg−1 during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to compare the effect of ketamine–propofol mixture (ketofol) and propofol on the laryngeal tube-Suction II (LTS II) insertion conditions and hemodynamics. Methods: Eighty American Society of Anesthesiologists class 1 and 2 patients were divided into 2 random groups to receive either 1 µg/kg remifentanil and propofol 2 mg/kg in Group P (n = 40), or 1 µg/kg remifentanil and ketofol (using a 1:1 single syringe mixture of 5 mg/mL ketamine and 5 mg/mL propofol) in Group K (n = 40) before induction of anesthesia. After induction, LTS II was inserted. Heart rate and noninvasive blood pressure were recorded before induction of anesthesia (t0); immediately following induction (t1); immediately after LTS II insertion (t2); and 3 minutes (t3), 5 minutes (t4), and 10 (t5) minutes after LTS II insertion. Conditions of insertion of LTS II were assessed and scored 1 to 3 using 6 variables as follows: mouth opening, swallowing, coughing, head and body movements, laryngospasm, and ease of LTS II insertion by the same experienced anesthesiologist who did not know the agents. LTS II insertion summed score was prepared depending upon these variables. Results: In regard to LTS II insertion summed score, Group K was more favorable than Group P (P < 0.05). Apnea duration was longer in Group P (385.0 seconds [range = 195.0–840.0 seconds]) compared with Group K (325.50 seconds [range = 60.0–840.0 seconds]) but this was not statically significant. The heart rate values were significantly lower at all measurement intervals in both groups compared with the baseline values (P < 0.05). There was no difference in heart rate between Group P and Group K. The mean arterial pressure values were significantly lower at all measurement intervals in Group P compared with baseline values (P < 0.05). In Group K, the mean arterial pressure values were significantly lower at all measurement intervals compared with the baseline values, except t2 (P < 0.05). There was a significant difference between Group P and Group K in terms of mean arterial pressure at t3 (P < 0.05). Conclusions: We found that ketofol provided better insertion summed score for LTS II than propofol, with minimal hemodynamic changes. [Copyright &y& Elsevier]