Laparoscopic Cholecystectomy, Optic Nerve Sheath Diameter Measurement, Ketamine, Postoperative Pain
Conditions
Brief summary
This prospective, randomized, controlled study evaluated the effects of different ketamine administration strategies in adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Participants were randomized into three groups: bolus ketamine, continuous ketamine infusion, or control without ketamine. The study investigated the effects of these strategies on optic nerve sheath diameter measured by ultrasonography as a surrogate marker of intracranial pressure, intraoperative sevoflurane consumption, and postoperative pain and analgesic requirements.
Interventions
DRUGketamine bolus
Ketamine 0.25 mg/kg was administered intravenously as a bolus after the initiation of remifentanil infusion following endotracheal intubation. The same dose was repeated if the duration of surgery exceeded 60 minutes.
DRUGketamin infusion
Ketamine was administered intravenously at 0.25 mg/kg/hour after the initiation of remifentanil infusion following endotracheal intubation and was continued until the end of surgery.
OTHERNormal Saline
Participants in the control group did not receive ketamine. A 100 mL normal saline infusion was initiated concurrently with the remifentanil infusion.
Sponsors
Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 65 years * Scheduled for elective laparoscopic cholecystectomy * American Society of Anesthesiologists (ASA) physical status I or II * Body weight ≥45 kg * Body mass index (BMI) \>18 kg/m² and \<32 kg/m² * Provision of written informed consent
Exclusion criteria
* Refusal to participate in the study * Uncontrolled hypertension * Uncontrolled diabetes mellitus * History of malignancy * Severe cardiovascular or cerebrovascular disease, including congestive heart failure, myocardial infarction, or previous stroke * Hepatic or renal dysfunction * Pregnancy or lactation * Intracranial space-occupying lesion or any condition associated with increased intracranial pressure * Known optic nerve pathology * Intraoperative complications requiring discontinuation from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Optic Nerve Sheath Diameter | Pre-anesthesia; 5 minutes after intubation; 5 minutes after initiation of the study intervention; 5 minutes after pneumoperitoneum; 5 minutes after reverse Trendelenburg positioning; 30 minutes after intubation; and 5 minutes after desufflation. | Optic nerve sheath diameter (ONSD) was measured using ocular ultrasonography. Measurements were obtained bilaterally at 3 mm posterior to the globe, and the mean of four consecutive measurements was recorded. ONSD was evaluated to assess changes associated with different ketamine administration strategies during laparoscopic cholecystectomy. |
Countries
Turkey (Türkiye)
Outcome results
None listed