Usefulness of Ketamine versus Fentanyl as adjuvants with Dexmedetomidine infusion on perioperative hemodynamics and recovery profile

Perioperative use of dexmedetomidine as an adjunct to general anaesthesia has smooth and haemodynamically stable intraoperative and post-operative course and analgesic and anaesthetic sparing effect and cardiovascular stabilising effects without respiratory depression

Slow onset of action of dexmedetomidine is the major limitation of its use

Fentanyl with dexmedetomidine has explicated a better clinical outcome compared to dexmedetomidine

But the cardiorespiratory depressant effect of opioids can aggravate the well-known side effects of dexmedetomidine like bradycardia and hypotension

Ketamine an NMDA receptor antagonist causes tachycardia hypertension salivation nausea and emergence delirium but has a faster onset of action

Thus the antagonising adverse effect profile of the two drugs can have a synergistic combination allowing smoother anaesthesia and recovery profile

The use of ketamine allows faster onset of action thereby eliminating the slower onset seen with dexmedetomidine alone

Also it has been studied with several adjuvants for effect potentiation

This study aims to compare the clinical effects and recovery characteristics of intraoperative dexmedetomidine with ketamine versus dexmedetomidine with fentanyl infusion

 Comparison of outcomes will be based on

1 Intraoperative hemodynamics

2 Postoperative analgesia

3 Adverse effects