title: Comparison of intravenous ketorolac and alfentanil as supplements to propofol anesthesia for diagnostic panendoscopy.
abstract: OBJECTIVE
  To determine if ketorolac tromethamine is an acceptable alternative to alfentanil as a supplement to propofol for diagnostic panendoscopy.
  
  
  METHODS
  Randomized, double-blind study.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  40 patients scheduled for panendoscopy and laryngeal tissue biopsy.
  
  
  METHODS
  Patients were randomly assigned to receive either alfentanil 14.5 micrograms/kg or ketorolac 1.0 mg/kg in a double-blind fashion, 5 to 10 minutes before induction of general anesthesia.
  
  
  RESULTS
  Heart rate (HR) and noninvasive blood pressure (BP) were measured and recorded before and immediately after injection of the study drug, after laryngoscopy for the endotracheal tube placement, and after initiation of diagnostic panendoscopy. Bleeding in the operative field was rated by the endoscopist. Observation from discontinuation of the propofol infusion and nitrous oxide inhalation to eye opening, head lifting, and orientation to time and place was observed and recorded. The presence of stridor after extubation, and pulse oximeter-determined arterial blood oxyhemoglobin saturation immediately after extubation and 5 minutes later, were noted. In the recovery room, the ability to tolerate oral fluids, sit, stand, and walk were recorded. Supplementation with ketorolac provides faster recovery from anesthesia as evidenced by shorter time to eye opening, head lifting, and orientation to time and place. However, no intergroup differences were found in measured intraoperative variables (BP and HR following laryngoscopy, tracheal intubation, diagnostic panendoscopy, and tissue biopsy). Operative site bleeding was comparable in both groups. The variables reflecting street readiness and the incidence of nausea and vomiting were statistically comparable.
  
  
  CONCLUSIONS
  Supplementation of propofol anesthesia with ketorolac is an efficacious alternative to supplementation with alfentanil. The faster recovery in the ketorolac group is explained by the mostly peripheral effect of this drug, whereas the slow decline in the alfentanil concentration at the effective site may be responsible for slower emergence from anesthesia.
authors.affiliation: H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa 33612-4799, USA.
authors.forename: V
authors.initials: V
authors.lastname: Bosek
authors.forename: D B
authors.initials: DB
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Endicott
authors.forename: D
authors.initials: D
authors.lastname: Klotch
authors.forename: M
authors.initials: M
authors.lastname: Ridley
mesh_terms: D015760:Alfentanil / Q000008:administration & dosage*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001706:Biopsy / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects; D020911:Ketorolac Tromethamine; D007818:Laryngeal Diseases / Q000209:etiology; D007828:Laryngoscopy; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010108:Oxyhemoglobins / Q000032:analysis; D015742:Propofol / Q000008:administration & dosage*; D012135:Respiratory Sounds / Q000209:etiology; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014325:Tromethamine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010108:Oxyhemoglobins; D014325:Tromethamine; D015760:Alfentanil; D020911:Ketorolac Tromethamine; D014046:Tolmetin; D015742:Propofol