Comparative impact of ketofol vs propofol on postoperative cognitive, functional and pain outcomes in surgical patients

Postoperative cognitive dysfunction is an emerging condition associated with surgery under general anesthesia, especially in elderly patients, with major detrimental health effects. To optimize anesthetic drug use, the study aimed to evaluate the effects of ketofol (ketamine-propofol combination) on postoperative cognition, pain, and functional recovery in comparison with propofol. In this prospective, observational, and comparative study, 52 patients were enrolled and divided into two groups based on the anesthetic agent employed for induction: either ketofol (Group KP) or propofol (Group P). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) preoperatively and at 2, 24 and 48 hours post-surgery. Functional recovery was examined using the Modified Aldrete Score (MAS), and pain levels were recorded at the same time intervals using the Visual Analog Scale (VAS). Hemodynamics were also monitored during the procedure. Data were initially analyzed using the Mann-Whitney U Test and student’s t-test; subsequently, Linear Mixed Models (LMM) were employed to adjust for potential covariates. MoCA scores at 24 and 48 hours were significantly higher in the ketofol group (p = 0.001 and p = 0.002), but MMSE scores showed no statistical difference. Pain scores were significantly lower in the ketofol group at 2, 24, and 48 hours (p = 0.010, p = 0.001, and p = 0.0001). However, LMM did not confirm these findings as statistically significant. Ketofol demonstrated better hemodynamic stability, especially in terms of systolic and diastolic blood pressure and SpO2 readings. Although Ketofol was associated with better postoperative cognitive preservation, pain control, and hemodynamic stability compared to propofol in the unadjusted analyses, adjusted models indicated that these differences could be influenced by confounders such as age and gender, necessitating further investigation into its clinical use.
Keywords:
Cognitive dysfunction; Ketofol; Propofol; Pain; Postoperative; Recovery of function