Vergleich von Sufentanil mit S(+)-Ketamin zur Supplementierung einer total-intravenösen Anästhesie mit Propofol

The aim of this study was to compare the clinical feasibility and the management of a TIVA with Propofol and Ketamine with a standard TIVA from Propofol and Sufentanil by means of the incidence of side effects. 120 patients of the ASA-groups I-III, comparable with respect to demographic and biometric data were randomly assigned to one of the two studied groups. During the operation they were given a TIVA using Propofol and Ketamine (group A) or a TIVA with Propofol and Sufentanil (group B). Although the patients of group A dreamt more than the patients of group B, these dreams were not more negative; the acceptance of the anesthesia was good and equally high in both groups. Although the intraoperative control of both anaesthesias differed in the frequent necessity of antihypotensive intervention in group B, the difference was only marginal. The return of the cognitive ability and the move from the wake-up-room up to the station in an equally fast and good way did not differ between the two groups. Despite a comparable baseline risk for PONV, nausea and vomiting was more seldom in group A, taking as a basis the impact of PONV there was significance on the 2 percent-level (p=0,016). In this way Ketamine reduces efficiently the impact of postoperative nausea and vomiting compared with Sufentanil. The need for postoperative pain killers was lower in the Ketamine group, but it did not reach statistical significance (p=0,18). Nonetheless these results show that the combination of Propofol and Ketamine in regard to the pain therapy can be regarded as equal. With the same side effects it can be recommended to patients who have to avoid opioids. At the same time the combination of Propofol and Ketamine stabilizes the blood circulation during the anesthesia and can therefore be recommended to patients who have a low blood pressure.