Comparison of Two Drug Combinations in Total Intravenous Anaesthesia: Propofol-Ketamine and Propofol-Fentanyl


  • Jeet R Arya SMIMER, Surat
  • Bhavna H Sojitra SMIMER, Surat
  • Malti J. Pandya SMIMER, Surat



Total Intravenous Anaesthesia, propofol, ketamine, fentanyl


Introduction: TIVA has many advantages over inhalational anaesthesia such as minimal cardiac depression, decreased oxygen consumption, avoids postoperative diffusion hypoxemia, decreases the incidence of postoperative nausea and vomiting etc. This study was conducted to evaluate and compare two TIVA drug combinations using propofol- ketamine and propofol-fentanyl, and to examine the characteristics of induction of anaesthesia, maintenance, and recovery.

Method: 34 patients of ASA grading 1,2 and 3 aged between 20 to 65 years of either sex undergoing short surgical procedures were included in the study. According to Comparison of systolic blood pressure of both the groups at intubation time of anaesthesia in group I and group II. Patients in group I received propofol and ketamine intravenously (IV) to induce anaesthesia. For group II, fentanyl and propofol were administered as IV bolus doses. All the results were tabulated and analyzed statistically.

Result: Propofol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressures as compared to propofol-ketamine during induction of anaesthesia. Propofol-ketamine combination produced stable hemodynamic during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II.

Conclusions: Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anaesthesia with only a few untoward side effects and only minor hemodynamic effects.


Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combina-tions in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl. Saudi J Anaesth 2010;4:72-9. Doi: PMid:20927266 PMCid:PMC2945518

Mayer M, Ochmann O, Doenicke A, Angster R, Suttmann H. The effect of propofol-ketamine anesthesia on hemodynamics and analgesia in comparison with propofol-fentanyl. Anaes-thesist 1990;39:609-16.

Mi WD, Sakai T, Takahashi S, Matsuki A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth 1998;45:19-22. Doi: PMid:9466021

Nielsen PF, Ahlburg P, Sosted EE, Christensen JH. The dosage-effect-curves for propofol in young and elderly patients and modifications of these following fentanyl. Ugeskr Laeger 1992;154:1907-10.

Hernandez C, Parramon F, Garcia-Velasco P, Vilaplana J, Garcνa C, Villalonga A. Comparative study of 3 techniques for total intravenous anesthesia: Midazolam-ketamine, propofol-ketamine, and propofol-fentanyl. Rev Esp Anestesiol Reanim 1999;46:154-8.

Billard V, Moulla F, Bourgain JL. Megnigbeto A, Stanski DR. Hemodynamic response to induction and intubation: Propofol/fentanyl interaction. Anesthesiology 1994;81:1384-93. Doi: PMid:7992907

Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J. Additive interactions between propofol and ketamine when used for anesthesia induction in female patients. Anesthesiology 1995;82:641-8. Doi: PMid:7879932

Kurt E, Cosar A, Bilgin F. Comparison of the combinations of propofol/ketamine, propofol/fentanyl and propofol/alfentanyl on the quality of induction, intubation, hemodynamics and recovery, for providing analgesia in TIVA. Minerva Anestesiol 1990;56:817-9.

Gill SS, Wright EM, Reilly CS. Pharmacokinetic interaction of propofol and fentanyl: Single bolus injection study. Br J Anaesth 1990;65:760-5. Doi: PMid:2265045

Ghabash M, Matta M, Kehhaleh J. Depression of excitatory effects of propofol induction by fentanyl. Middle East J Anes-thesiol 1996;13:419-25.

Benito MC, Gonzalez-Zarco LM, Navia J. Total intravenous anesthesia in general surgery. Rev Esp Anestesiol Reanim 1994;41:292-5.

Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Can J Anaesth 1991;38:330-4. Doi: PMid:2036693

Steward DJ. A simplified scoring system for the postoperative recovery room. Canad Anaesth Soc J 1975;22:111-2. Doi: PMid:1109700

Schuttler J, Schuttler M, Kloos S, Nadstawek J, Schwilden H. Optimal dosage strategies in total intravenous anesthesia using propofol and ketamine. Anaesthesist 1991;40:199-204.

Dunnihoo M, Wuest A, Meyer M, Robinson M. The effects of total intravenous anesthesia using propofol, ketamine, and vecuronium on cardiovascular response and wake up time. AANA J 1994;62:261-6.

Bell J, Sartain J, Wilkinson GA, Sherry KM. Propofol and fen-tanyl anaesthesia for patients with low cardiac output state un-dergoing cardiac surgery: Comparison with high-dose fentanyl anaesthesia. Br J Anaesth 1994;73:162-6. Doi: PMid:7917729

Kazama T, Ikeda K, Morita K, Sanjo Y. Awakening propofol concentration with and without blood-effect site equilibration after short-term and long-term administration of propofol and fentanyl anesthesia. Anesthesiology 1998;88:928-34. Doi: PMid:9579501

Han T, Kim D, Kil H, Inagaki Y. The effects of plasma fentanyl concentrations on propofol requirement, emergence from anesthesia, and postoperative analgesia in propofol-nitrous ox-ide anesthesia. Anesth Analg 2000;90:1365-71. Doi: PMid:10825322

Jakobsson J, Oddby E, Rane K. Patient evaluation of four different combinations of intravenous anaesthetics for short outpatient procedures. Anaesthesia 1993;48:1005-7. Doi: PMid:8285950




How to Cite

Arya, J. R. ., Sojitra, B. H. ., & Pandya, M. J. . (2022). Comparison of Two Drug Combinations in Total Intravenous Anaesthesia: Propofol-Ketamine and Propofol-Fentanyl. National Journal of Medical Research, 12(04), 77–82.



Original Research Articles