A comparative study of ketofol and fentafol for evacuation of retained products of conception (ERPC)

Background: Intravenous balanced anesthesia (IVA) is desirable during the evacuation of retained products of conception (ERPC) to avoid the use of inhalational anesthetics agents that may cause uterus relaxation, the possibility of bleeding, and the risk of uterus perforation.Objectives: The aim of this study was to compare the efficacy and safety of ketofol (a mixture of propofol and ketamine) versus fentafol (a mixture of propofol and fentanyl) during the ERPC.Methods: A double-blind, randomized comparative study was conducted among a total of 60 women of childbearing age categorized as grades I and II according to the American Society of Anesthesiologist (ASA), presented for ERPC. The patients were selected and randomized blindly into two groups (K group and F group), with 30 patients in each group. The K group was given ketofol (1ml containing 5mg of propofol and 5mg of ketamine) and F group was given fentafol (1ml containing 5mg propofol and 5mcg fentanyl). An intravenous loading dose of ketofol or fentafol was given slowly, with doses ranging from 1ml to 2ml/10kg, to reach level 5 or 6 of the Ramsay Scale of Sedation (RSS), followed by small incremental doses which were given when RSS dropped to 4. Hemodynamic parameters, success, and side effects were assessed throughout the procedures.Results: K group demonstrated a significant increase in heart rate (HR) and blood pressure (BP), compared to significant decreases in the F group. Decreases in oxygen saturation (SpO2) and respiratory rate (RR) were observed more in the F group. However, no patients developed hypertension, hypotension, apnea, hypoxemia or serious adverse effects. Ketofol showed less propofol consumption and a short recovery time.Conclusions: Both ketofol and fentafol offer optimum conditions for ERPC. Ketofol is characterized by more stable hemodynamic parameters, a smaller dosage and faster recovery. [Ethiop.J. Health Dev. 2019; 33(2):88-93]Key words: Propofol, ketamine, fentanyl, retained products of conception (RPC), ketofol, fentafo

Determinants of Depression among poor Elderly Women: Findings from refugee and non-refugee Communities in the Outskirts of Beirut, Lebanon

Background. Depression among elderly females is an important public health concern. The present study aims at examining factors associated with female elderly depression in three underprivileged communities in Lebanon, one of which is almost solely inhabited by Palestinian refugees. Methods. Four hundred and twenty-two women age 60-93 years were interviewed. Depression was assessed using the Geriatric Depression Scale (GDS). Results. Probable and definite depression was diagnosed in 74.5% and 29.6% of the women respectively. Following multivariate analysis, factors significantly associated with definite depression were Palestinian nationality, dissatisfaction with household income, lack of physical activity, and disability. Conclusion. Findings highlight the need for greater efforts to provide a suitable environment for exercise for elderly. Policy makers need to improve the living conditions of the underprivileged communities in Lebanon, particularly Palestinian refugees