Effect of ketofol versus propofol on cerebral oxygenation in patients undergoing transsphenoidal pituitary surgery under total intravenous anesthesia – A randomized control trial

Objectives: Ketofol has been postulated to have stable hemodynamics, early emergence, and reduced complications compared to propofol. However, their effect on cerebral oxygenation is not well studied. This study compared the effect of both drugs on regional cerebral oxygenation (rSO 2 ) in neurosurgical patients undergoing transsphenoidal pituitary surgery. Materials and Methods: In this prospective, randomized, and double-blind trial, 50 adult patients scheduled for elective transsphenoidal pituitary surgery were assigned to receive either ketofol ( n = 25) or propofol ( n = 25) for induction and maintenance of anesthesia. Intraoperative rSO 2 values [right (R) and left (L)] and hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO2)] were recorded at various time points, along with total analgesic requirement, emergence from anesthesia, and duration of post-operative analgesia. Results: After administration of the study drug, rSO 2 (R, L) significantly increased in the ketofol group but decreased in the propofol group compared with baseline values ( P < 0.05). Between groups, rSO 2 values were consistently higher with ketofol ( P < 0.05). Propofol was associated with greater hemodynamic (HR and MAP) variations and a higher incidence of intraoperative hypotension (60% vs. 12%, P < 0.001). Patients in the ketofol group required less intraoperative analgesia ( P < 0.001), had faster emergence ( P < 0.001), shorter duration of anesthesia ( P = 0.031), and longer post-operative analgesia ( P < 0.001). Conclusion: Compared with propofol, ketofol improves cerebral oxygenation and provides superior hemodynamic stability, rapid emergence from anesthesia, and prolonged post-operative analgesia while reducing intraoperative analgesic requirements.