Prospective observational comparison of propofol–ketamine, propofol–fentanyl, propofol– dexmedetomidine combinations on intraoperative hemodynamics, post-operative recovery in upper abdominal surgery

Abstract

Balanced general anesthesia optimization remains challenging as propofol adjuvants (dexmedetomidine, fentanyl, ketamine) uniquely affect intraoperative hemodynamics and post-operative recovery profiles. Therefore, it is of interest to compare the propofol-dexmedetomidine (PD), propofol-fentanyl (PF) and propofol-ketamine (PK) in 114 ASA I-II patients (18-65 years) undergoing elective upper abdominal surgery. PD provided superior hemodynamic stability (reduced HR/BP versus PK/PF; p<0.05), while PF achieved fastest recovery; PK minimized post-operative analgesic needs across VAS assessments. Oxygen saturation and EtCO2 remained comparable (p>0.05), through PD showed deeper sedation (Modified Ramsay) versus PF's rapid Aldrete recovery. Thus, data shows the adjuvant-specific profiles—PD for stability, PF for recovery speed, PK for analgesia, enabling clinical goal-directed anesthetic selection.