Objective: We recorded the data of patients performing Percutaneous Nephrolithotomy\n(PCNL) under combined spinal anesthesia with sedative mixtures\nof Ketamine-Propofol (KP) or Fentanyl-Propofol (FP). Background: The\nPCNL is usually done under General anesthesia (GA); combining spinal\nanesthesia with a mixture of sedative drugs has shown to provide an optimum\nintra and post-operative analgesic and sedative response without side effects.\nPatients and Methods: 100 healthy patients were enrolled for PCNL, after\nstabilization of the sensory block of spinal anesthesia patients were randomized\ninto two groups; Group KP received 1 mg/Kg Ketamine and 1 mg/Kg\nPropofol diluted in 20 ml syringe given over 30 seconds and Group FP received\n1 mic/Kg Fentanyl and 1 mg/Kg Propofol diluted in 20 ml syringe over\n30 seconds; both groups will receive increment doses if the patient suffers\nfrom anxiety, pain or discomfort. Perioperative Hemodynamic data (HR, SBP,\nDBP, RR, and SpO2) were recorded; PACU stay time and post operative\nanalgesia time were analyzed. Results: Sedative mixtures of FP and KP provided\nremarkably deep sedation levels for PCNL procedures under spinal\nanesthesia. Respiratory depression, hypotension and bradycardia were the\nmajor side effects reported in FP group which had mean decrease in RR of\n4.63 breath/min (27.49%) with mean 3.77% drop in SpO2 levels. KP group\nproduced significant increase in HR about 7 beats/min without reported side\neffects. Conclusion: Various sedation techniques may be applicable for PCNL\nprocedures with routine premedication, mixtures of fentanyl-Propofol or Ketamine-\nPropofol could be used, and KP has advantages of stable hemodynamics,\nprolonged analgesic response intra and post-operatively with no appreciable\nside effects and more effective method of sedative mixture.
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