الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 125 |  |  |
| | | from | 125 | | |
Abstract
Background : Propofol is used increasingly for the induction and maintenance of anesthesia. Its use is characterized by rapid clearance and distribution, resulting in rapid emergence from anesthesia. Ketamine has gained attention as an analgesic for total intravenous anesthesia. Sevoflurane has an intrinsic dose-dependent cerebral vasodilatory effect less than that reported for halothane and isoflurane. Transcranial Doppler (TCD) is a non invasive ultrasonic technique that measures local blood flow velocity and direction in the proximal portions of large intracranial arteries. Aim of work: to evaluate the effects of propofol alone, ketamine alone, propofol-ketamine versus sevoflurane on human middle cerebral artery blood flow velocity by using transcranial Doppler ultrasonography during orthopedic surgeries. Methods: In this study 120 patients ASA I-II aged 20-40 years were selected and randomly distributed into four groups of 30 patients each. All patients received epidural block. Group P received propofol 1.5-2 mg/kg induction and anesthesia was maintained with propofol infusion 12mg/kg/h for the first 15 min, then 9mg/kg/h for the next 25 min and then 6 mg/kg/h till the end of surgery. Group K received ketamine induction 1.5-2 mg/kg then anesthesia was maintained with ketamine infusion 2 mg/kg/h. Group PK anesthesia was induced with propofol 1 mg/kg and ketamine 1 mg/kg, anesthesia was maintained with continuous infusion of ketamine 1 mg/kg/h and propofol 6 mg/kg/h for the first 15min, then 4 mg/kg/h for the next 25 min and then 3 mg/kg/h till the end of surgery. Group S anesthesia was induced with sevoflurane 8 MAC in 100% O2 in 9 lit/min. Routine intraoperative monitoring of continuous non invasive blood pressure measurement, HR, pulse oximetry, end tidal CO2 and TCD ultrasonography assessment: basal, post induction, post intubation and every 30 min. Results: Our results showed significant reduction of Vmca and MABP in group P, propofol decreased Vmca and MABP. Conclusion: We found a decreased both cerebral blood flow velocity and systemic blood pressure at propofol anesthesia and an increase in systemic blood pressure, cerebral blood flow velocity at ketamine and sevoflurane anesthesia. These findings may have important implications in the neurosurgical setting.