الفهرس 
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Abstract
This study was done to compare the combination of propofol-ketamine and the combination of propofol-fentanyl as total intravenous anaesthesia for laparoscopic cholecystectomy and this comparison was as regard hemodynamic state, recovery and postoperative side effects in patients of both groups, so a randomized controlled study was conducted at Sohag University Hospital. The study included 80 patients ASA I and ASA II scheduled for elective laparoscopic cholecystectomy. They were divided into two groups, group І (40) patients and group ІІ (40) patients. All patients were informed about the procedure and the anesthetic technique. perioperative hemodynamics were recorded, Modified Aldrete Score and postoperative side effects in both groups.
Group I (propofol-ketamine) showed increase in pulse rate post induction then returned towards baseline pulse. Group II (propofol-fentanyl) showed decrease in pulse rate post induction then returned towards baseline pulse all the remaining period of operation and postoperative. The difference between both groups was significant during induction and postoperative periods. Group I showed decrease in systolic blood pressure post induction which returned gradually to baseline SBP. In group II there was decrease which was significant after induction also there was significant difference in both groups with group II showed more decrease than group I. Group I showed increase in DBP through post induction period then returned towards baseline DBP. Group II showed decrease through the post induction period but the difference between both groups was significant with group II had more decrease than group I. Group I showed stability in the mean arterial blood pressure all over the periods with increase within 10% of baseline MAP. Group II showed decrease in MAP at beginning of induction time and continued throughout intraoperative period but within 5%-10% of baseline MAP. The difference was significant between both groups in the postinduction period and first half of intraoperative period. Both groups showed insignificant change from baseline as regard SPO2. Group II showed better Modified Aldrete Score and more rapid recovery than group I. The difference is significant between both groups. Group I had post operative nausea in 10 cases and vomiting in 5 cases also ten cases had hallucination while group II showed nausea in 5 cases only.
Conclusion
Based on the scope and findings of this study, it was concluded that TIVA with propofol-ketamine or propofol-fentanyl is a useful, safe, effective and easy anaesthetic technique for laparoscopic cholecystectomy.
Recommendations:
1. Randomized control studies should be conducted using other agents like, alfentanil, remifentanil and midazolam for TIVA for anaesthesia of laparoscopic cholecystectomy.
2. Use of TIVA in laparoscopic cholecystectomy for patients ASA III and ASA IV.