A randomized comparative study of two different concentrations of ketamine and propofol combination in upper gastrointestinal endoscopy procedures

Abstract

Background: Ketofol is a mixture of ketamine and propofol. It is one of the agents known to achieve procedural sedation and analgesia. Aim of the study: This prospective randomized study compared the effectiveness and safety of two doses of ketofol in morbidly obese patients undergoing diagnostic upper gastrointestinal endoscopy. Methods: The study included 100 adult patients, American Society of Anesthesiologists II and III. The patients were divided into two equal groups; group I in which the ketamine dose equal the propofol dose (k/p 1:1), n=50, and group II in which ketamine dose equal ¼ of the propofol dose (k/p 1:4), n=50. In separate syringes, ketamine 1mg/kg plus propofol 1mg/kg were injected intravenously in group I. In group II, patients are given ketamine 0.25 mg/kg plus propofol 1mg/kg. The bispectral index values, intraoperative hemodynamic changes, respiratory profiles, visual analog scale pain score, and adverse events were recorded. Results: No statistically significant difference between both groups regarding bispectral index values, hemodynamics, respiratory profiles, and visual analog scale pain score. The time needed to discharge patients from the postanesthetic care unit was prolonged in group I (39 min) compared with group II (32 min). Recovery agitation was reported in 5 patients in group I. Conclusion: Both concentrations of ketamine and propofol are effective and safe in the sedation of obese patients. It is recommended to use the combination of ketamine and propofol (k/p 1:4) because this concentration is associated with a short recovery and less psychotomimetic side effects.

Fentanyl-Propofol Versus Ketamine-Propofol Combination for Sedation and Recovery in ERCP: A Double-Blinded Randomized Clinical Trial

“…Better patient compliance and comfort during the surgery are guaranteed by closely monitored anaesthesia care. 1,2 ERCP involves sedation, by lowering pain, discomfort, and stress, this helps patients tolerate unpleasant and time-consuming procedures (like ERCP). 3,4 Additionally, they can make the task of the endoscopist simpler and reduce the risk of harm during ERCP.…”

“…3,4 Additionally, they can make the task of the endoscopist simpler and reduce the risk of harm during ERCP. 1,5,6 Adverse intraoperative and postoperative events that have been recorded during sedation for ERCP include hypoventilation, hypoxemia, respiratory arrest, airway obstruction, dysrhythmias, hypotension, and vasovagal episodes. 1,4,5 The gold standard diagnostic and therapeutic approach for pancreaticobiliary diseases is the ERCP, which is frequently carried out in daycare.…”

“…1,5,6 Adverse intraoperative and postoperative events that have been recorded during sedation for ERCP include hypoventilation, hypoxemia, respiratory arrest, airway obstruction, dysrhythmias, hypotension, and vasovagal episodes. 1,4,5 The gold standard diagnostic and therapeutic approach for pancreaticobiliary diseases is the ERCP, which is frequently carried out in daycare. 2 Through ERCP, procedures like stenting, stone removal, pancreatic-biliary tract visualization, laser lithotripsy, and sphincterotomy can all be carried out.…”

“…6 The ideal sedative-analgesic mixture ought to preserve a patient's hemodynamic status and ought to cause no breathing depression, a quick onset and reversal to initial values, and a small occurrence of postoperative nausea and vomiting. 1,2,6 Several pharmacological medicines, including dexmedetomidine, fentanyl, ketamine, and propofol, are now widely accessible, taking into consideration short induction, rapid recovery, and lessening complications associated with using a single drug. 6 Additional small doses of supplementary medicines example ketamine and fentanyl are recommended as propofol, if administered in excess to deepen anaesthesia can have significant cardiac adverse effects.…”