Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy

Abstract

Background: Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy. Methods: The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses. Results: In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D ( P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation. Conclusion: Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.

The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

“…Our findings revealed that esketamine had quicker onset than dexmedetomidine. The respective onset time was 12 (95% CI, 10.25–14) min in Group D and 2 (95% CI, 2–3) min in Group K, which was consistent with Pees’ ( Pees et al, 2003 ) and Tekeli’s research ( Tekeli et al, 2020 ). Our difference from Pee’s research ( Pees et al, 2003 ) was the subjects were adults in Pee’s but children in ours.…”

Sedative effect and safety of different doses of S-ketamine in combination with propofol during gastro-duodenoscopy in school-aged children: a prospective, randomized study

“…The 0.5 mg.kg −1 of ketamine can increase the BIS value but not 0.2 mg.kg −1 . In adults receiving gastroscopy, it has also been shown that the BIS value in patients receiving propofol combined with ketamine was significantly higher than that in patients receiving propofol combined with dexmedetomidine (Tekeli, et al, [ 21 ]). Similar results were also obtained in this study.…”

Effects of different insulation temperatures of an inflatable insulation system on patients receiving right hemicolectomy using the laparoscopic caudal approach

“…The BIS value was 85-100 normally, 65-85 for a sedated state, 45-65 for an anesthetic state, and below 40 for a burst suppression state [9,10]. Moreover, relevant studies have shown that following rapid metabolism in the body, the changes in plasma concentration or effect compartment concentration of propofol were remarkably associated with sedation changes monitored by BIS [11,12]. Therefore, this study was carried out to measure BIS value at propofol discontinuation, time from propofol discontinuation to BIS ≥ 80, and propofol effect compartment concentration at BIS ≥ 80.…”