A COMPARISON BETWEEN KETAMINE,CLONIDINE AND COMBINATION OF KETAMINE-CLONIDINE FOR THE

PREVENTION OF POSTANAESTHETIC SHIVERING

By- Asim AbinashKrishna BollojulaShubham SharmaSoham MukhopadhyaySuddhasheel BhattacharyaSwapnasis Mohanty

AGENDA

• Introduction Data Given Objective

• Demographical Analysis• Pre-op and Post-op Analysis• Final Results• Conclusion

Introduction

• Data Given Sample Size (120 Patients)

• Groups(4) Group-K(Single dose of Intravenous Ketamine [0.5mg/kg]) Group-C(Single dose of Intravenous Clonidine [1.5mg/kg]) Group-KC(Combination of Intravenous Ketamine [0.25mg/kg]and

Clonidine [o.75mcg/kg]) Group-P(Placebo)

• Objective To compare the efficacy of single dose intravenous ketamine and

intravenous clonidine and combination of intravenous ketamine plus clonidine in the prevention of shivering following general anesthesia.

DEMOGRAPHICAL ANALYSIS

After comparing the demographical data such as age, weight, height, date of surgery(dos) of patients across all four groups we have found that there was no significant statistical difference across the four groups. This result was concluded using anova test where the p – value for all the four groups was >0.05 (i.e. null hypothesis was accepted)

Pre-op and Post-op analysis

Parameters• Heart Rate

• Systolic Blood Pressure

Post-operative

• As there is significant difference in the mean value of all four groups i.e. all groups are equally unstable

• As there no significant difference in the mean value of group-KC, so Group –P is the most stable .

As there no significant difference in the mean value of group-KC, so Group -KC is the most stable .

As there no significant difference in the mean value of group-KC and Group-P , so Group -KC & Group-P are most stable .

Pre-operative

Parameters

• Diastolic Blood Pressure(DBP)

• Mean Arterial Pressure(MAP)

Post-operative

• As there is significant difference in the mean value of all four groups i.e. all groups are equally unstable.

• As there is significant difference in the mean value of all four groups i.e. all groups are equally unstable.

• As there no significant difference in the mean value of group-KC, so Group -KC is the most stable .

• Group-KC and Group- KC are having equally stable.

Pre-operative

Parameters

• Peripheral oxygen saturation (SPO2)

• Capnography (ETCO2 )

Post-operative

• As there no significant difference in the mean value of all four groups i.e. all groups are equally effective.

• As there no significant difference in the mean value of all four groups i.e. all groups are equally effective.

• As there no significant difference in the mean value of all four groups i.e. all groups are equally effective.

Pre-operative

Parameters

• Body temperatures-Surface

• Body temperatures-Surface -Core

Post-operative

• As there no significant difference in the mean value of all four groups i.e. all groups are equally effective.

• Only Group-P has no significant difference, the rest three group has significant difference.

Pre-operative

Adverse Effects

• Hypotension Group – K has no event of hypotension 50% of people in Group – P has hypotension Group-KC and Group –P has 17% event of hypotension

• Hypertension 50% of people in Group-K has hypertension Group- C has no event of hypertension 47% of people in Group-P has hypertension In Group-KC has more than 85% event of no hypertension

• Bradycardia 50% of people have bradycardia in Group-C More than 90% of people have no event of bradycardia in Group-K More than 85% of people have no event of bradycardia in Group-

KC and Group-P

• Tachycardia 60% of people have tachycardia in Group- K 80% of people do not have tachycardia in Group-C & Group-KC More than 65% of people do not have tachycardia in Group-C

• Nausea and Vomiting 90 % of the people in Group-K, Group-P & Group-KC has no

event of nausea and vomiting.

Group-C has highest events of nausea and vomiting.

• Shivering 50 % of the people in Group KC has no Shivering.

Group P has highest event of Shivering(Shiv>=3).

Group K and Group C has shivering levels between 1 and 2.

• Sedation Score High Variation of sedation Score in Group C (sed_score>=3).

More than 80% of people in Group K & Group P has score of 1.

More than 50% of people in Group KC has score of 1.

General Sedation Score scale.

Parameters Group-K Group-K Group-K&C Group-P

Pre-operative

Heart rate NE NE E NESystolic BP NE NE E NEDiastolic BP NE NE E NEMean Artrial pressure NE NE E NECore temprature NE NE NE E

Post operative

Heart rate NE NE NE NESystolic BP NE NE E NEDiastolic BP NE NE NE NEMean Artrial pressure NE NE NE NE

If there is less number of fluctuations from Base Line we have termed it as effective for that parcticular parameterIf there is high number of fluctuations from Base Line we have termed it as Not effective for that parcticular parameter

Overall Efficacy Of Drugs

Parameters Group-K Group-C Group-K&C Group-P

SHIVERING NORMAL NORMAL LOWEST HIGHESTSEDATION LOWEST HIGHEST NORMAL LOWESTHYPOTENSION LOWEST HIGHEST NORMAL NORMALHYPERTENSION HIGHEST LOWEST NORMAL HIGHESTBRADYCARDIA NORMAL HIGHEST NORMAL NORMALTACHYCARDIA HIGHEST NORMAL NORMAL NORMALNAUSEA & VOMITING LOWEST HIGHEST NORMAL NORMAL

SHIVERINGLOWEST LOWEST SHIVERING SCORE ACROSS GROUPSHIGHEST HIGHEST SHIVERING SCORE ACROSS GROUPSNORMAL ALL VALS IN BETWEEN

SEDATIONLOWEST LOWEST SED SCORE ACROSS GROUPSHIGHEST HIGHEST SED SCORE ACROSS GROUPSNORMAL ALL VALS IN BETWEEN

HYPOTENSIONLOWEST LOWEST HYPOTENSION ACROSS GROUPSHIGHEST HIGHEST HYPOTENSION ACROSS GROUPSNORMAL ALL VALS IN BETWEEN

Adverse Effects Of Drugs

Conclusion

From the tables it could be concluded that:

• Intravenous ketamine (0.25mg/kg) and clonidine(0.75mcg/kg)) combination works the best for most vital parameters with least adverse effects

Thank You