Addition of low-dose ketamine to midazolam-fentanyl-propofol–based sedation for colonoscopy: a randomized, double-blind, controlled trial

Tuncalı, Bahattin; Pekcan, Yonca Özvardar; Celebi, Arzu; Zeyneloğlu, Pınar

doi:10.1016/j.jclinane.2015.03.017

Cited by 19 publications

(12 citation statements)

References 26 publications

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“…The previous study demonstrated that a combination of ketamine and propofol (ketofol) provided better sedation quality than a combination of fentanyl and propofol, with less cardiorespiratory depression and appears to be a safe and useful technique for sedating obese patients underwent invasive GIE procedures [21] . Furthermore, the preferred effect of low-dose ketamine on the combination of other sedative drugs for colonoscopic procedure has been confirmed by Tuncali and colleagues [22] . Their randomized, double-blinded, placebo-controlled study demonstrated that a low-dose ketamine combined with propofol, midazolam and fentanyl for sedation in colonoscopic procedure resulted in better quality of sedation and more hemodynamic stability as well as less adverse effects.…”

Section: Discussionmentioning

confidence: 78%

Complication Rate of Propofol-Based Deep Sedation for Colonoscopy in Marked Obesity Patients

Amornyotin

2015

Journal of Gastroenterology and Hepatology Research

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AIM:To evaluate and compare the complication rate of propofolbased deep sedation (PBDS) for colonoscopy in marked obesity (BMI > 30) and non-obesity (BMI < 25) patients in a teaching hospital in Thailand. METHODS:We undertook a retrospective review of the sedation service records of adult patients who underwent colonoscopic procedures from December 2009 to April 2011. All patients were classified into two groups according to the body mass index (BMI). In group A, the patients had BMI < 25. In group B, the patients had BMI > 30. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure-related complications during and immediately after the procedure. RESULTS: After matching age, gender, ASA physical status, sedation time and indications of procedure, there were 100 colonoscopic procedures in group A and 33 colonoscopic procedures in group B. All sedation was given by residents or anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients' characteristics, sedation time, indication of procedure, overall complication rate, anesthetic personnel and mortality rate between the two groups. However, upper airway obstruction in group B was relatively higher than in group A. All complications were easily treated, with no adverse sequelae. CONCLUSION: PBDS for colonoscopic procedure in marked obesity patients by trained anesthetic personnel with appropriate monitoring was relatively safe and effective. The complication rate of this technique in marked obesity (BMI > 30) patients was not different or worse than in non-obesity (BMI < 25) patients. Serious complications were rare in our population.

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Section: Discussionmentioning

confidence: 78%

Complication Rate of Propofol-Based Deep Sedation for Colonoscopy in Marked Obesity Patients

Amornyotin

2015

Journal of Gastroenterology and Hepatology Research

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“…Patients sedated only with propofol need higher dose additional propofol than the patients sedated with the combination of alfentanil/ midazolam and with midazolam alone (9). In a study with incremental propofol administration in the midazolam/fentanyl and midazolam/ fentanyl/ketamine groups, propofol dose was found to be significantly lower in the second group (11). In the pre-anesthetic administration of fentanyl and propofol with and without midazolam, propofol consumption is lower in the midazolam (0.05 mg kg -1 ) group (17).…”

Section: Discussionmentioning

confidence: 96%

“…The probability of early discharge from PACU is an essential feature in the care of outpatients and produces better service and lower costs (24). Time to discharge was determined as 15 minutes according to the Modified Post-anesthetic Discharge Criteria (11). In another study, time to discharge was determined as 20 minutes in patients administered deep sedation (25).…”

Section: Discussionmentioning

confidence: 99%

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Sedation for Colonoscopy: Comparison of Remifentanil and Alfentanil Combined with Propofol/Midazolam

Arıcan¹,

Çiçekci²,

Hacıbeyoğlu³

et al. 2019

Istanbul Med J

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Amaç: Kolonoskopi işlemi uygulanan hastalara güvenli sedasyon ve erken taburculuk amacıyla farklı ilaç kombinasyonları kullanılmaktadır. Remifentanil ve alfentanil kısa etkili narkotik analjezik ajanlardır. Kısa etkili bir anksiyolitik ajan olan midazolam narkotik analjeziklerle kombine edildiğinde güçlü bir sedadif etkinliğe sahiptir. Kolonoskopi işlemi altındaki hasta da sedasyon amacıyla literatürde karşılaştırılmamış 2 opiodin propofol/midazolam ile kombinasyonunun etkinliğini karşılaştırmayı amaçladık. Yöntemler: Çalışmaya tanı ve/veya tedavi amaçlı kolonoskopi uygulanan 18 yaş üzeri yüz seksen dokuz hasta alındı. Alfentanil grubunda (grup A) 1 mg midazolam + 5 µg kg-1 alfentanil + 1 mg kg-1 propofol ve remifentanil grubuna (grup R) 1 mg midazolam + 0.1 µg kg-1 dk-1 remifentanil + 1 mg kg-1 propofol uygulandı. Hemodinamik veriler, Modifiye Steward skalası (MSS), Görsel Analog skala (VAS), ek propofol dozları, toplam işlem süresi, uyanma süresi, iyileşme süresi ve yan etkiler işlem sırasında kaydedildi. İşlem sonrası tüm hastalar derlenme odasına transfer edildi ve Modifiye Aldrete skalası (MAS) değerleri kaydedildi. Bulgular: Total propofol ve ek propofol dozlarında gruplar arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p<0.05), ve grup A da grup R ye göre propofol ek dozunun daha yüksek olduğu gözlenmiştir (p<0.05). Uyanma süresi gruplar arasında benzerdi. Derlenme süresinin grup A'da grup R'ye göre daha uzun olduğu tespit edildi (p<0.05). Gruplar arasında yan etkilerde anlamlı farklılık saptanmamıştır. Sonuç: Propofol/remifentanil ve propofol/alfentanil ile kombine edilen düşük doz midazolam etkili sedasyon ve analjezi sağlamasına rağmen, remifentanilin, farmakolojik özelliklerinden doğan avantajları nedeniyle kolonoskopi gibi günlük işlemler için ideal bir seçim olduğuna inanıyoruz.

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“…Sedoanaljezi için kullanılan ajanlar, hastanın yaşı ve vücut ağırlığı temel alınarak tek dozda verilmez. İntravenöz ilaçlar, istenilen sedoanaljezi düzeyine ulaşılıncaya kadar titre edilerek aralıklı artan dozlarda uygulanır (17,18). Bu nedenle çalışmamızda infüzyon şeklinde değil bolus dozlar uyguladık.…”

Section: Yöntemlerunclassified

Comparison of Ketamine, Fentanyl and Remifentanyl in Terms of Sedoanalgesia for Colonoscopy: A Randomized Prospective Double-blind Study

Şimşek¹,

Yüzkat²,

Soyalp³

et al. 2019

Haseki

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The aim of this study was to compare the effects of fentanyl, remifentanyl and ketamine applied for analgesia during colonoscopy on hemodynamics and sedo-analgesia quality. Methods: A total of 81 patients, who were scheduled for elective colonoscopy, were included in the study. Groups were randomized according to closed envelope method. Group K received 0.5 mg/ kg ketamine, group F, 1 µg/kg fentanyl, and group R received 1 µg/ kg remifentanil. Anaesthetist administered the analgesic agents at a dose of 1 mL/10 kg body weight without knowing the ingredient. Hemodynamic variables, total amount of propofol consumed, time of the endoscope to reach the cecum, and duration of colonoscopy were recorded. After the procedure, Modified Aldrete Score, patient, colonoscopist and anesthesiologist satisfaction were evaluated. Statistical analysis of the data was performed. Results: The demographic characteristics of the patients included in the study and the distribution of the patients between the groups were similar. There were no significant differences in duration of colonoscopy, hemodynamic changes, oxygen saturation, satisfaction scores, quality of analgesia, recovery and recovery after the procedure between the groups. Conclusion: As a result, ketamine, fentanyl, and remifentanyl applied for analgesia during colonoscopy have similar hemodynamic alterations and analgesic quality, therefore these agents may be substituted for one another for colonoscopy procedures.

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Addition of low-dose ketamine to midazolam-fentanyl-propofol–based sedation for colonoscopy: a randomized, double-blind, controlled trial

Cited by 19 publications

References 26 publications

Complication Rate of Propofol-Based Deep Sedation for Colonoscopy in Marked Obesity Patients

Complication Rate of Propofol-Based Deep Sedation for Colonoscopy in Marked Obesity Patients

Sedation for Colonoscopy: Comparison of Remifentanil and Alfentanil Combined with Propofol/Midazolam

Comparison of Ketamine, Fentanyl and Remifentanyl in Terms of Sedoanalgesia for Colonoscopy: A Randomized Prospective Double-blind Study

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