Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol

Abstract

BackgroundColonoscopy is performed without preparing sedation in many countries. However, according to the current literature patients are more satisfied when appropriate sedation is prepared for them.ObjectivesWe hypothesize that propofol-ketamine may prepare more patient satisfaction compared to propofol-fentanyl combination.Patients and MethodsSixty adult patients older than 18 with ASA physical status of I, II or III were enrolled in the present study after providing the informed consent. They were prospectively randomized into two equal groups: 1- Group PF: was scheduled to receive IV bolus dose of fentanyl 1µg/kg and propofol 0.5mg/kg. 2- Group PK: was scheduled to receive IV bolus dose of ketamine 0.5mg/kg and propofol 0.5mg/kg. As a primary goal, patient’s satisfaction was assessed by the use a Likert five-item scoring system in the recovery. Comparisons of hemodynamic parameters (mean heart rate, mean systolic blood pressure, mean diastolic blood pressure), mean Spo2 values during the procedure and side effects such as nausea, vomiting, and psychological reactions during the recovery period were our secondary goals. Level of sedation during the colonoscopy was assessed with the Observer’s Assessment of Alertness/Sedation score (OAA/S).ResultsMean satisfaction scores in the group PK were significantly higher than the group PF (P = 0.005) while the level of sedation during the procedure was similar (P = 0.17). Hemodynamic parameters and SpO2 values were not significantly different (P > 0.05). Incidence of nausea and vomiting was the same in both groups.ConclusionsIV bolus injection of propofol-ketamine can lead to more patients’ satisfaction than the other protocols during colonoscopy.

Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients

“…Contradicting our findings Ghadami et al reported longer recovery duration with propofol in a group of 60 pediatric patients [18]. Khajavi et al reported similar recovery durations for ketamine-propofol and fentanyl-propofol in colonoscopy patients [19]. We believe that these differences might be secondary to study population characteristics.…”

Clinical Efficacy of Combination of Propofol and Ketamine(Ketofol) for Deep Sedation in Colonoscopic Procedure

“…However, the patient's satisfaction in the ketofol group was relatively greater than in the propofol alone group. The previous studies also confirmed that the combination of propofol and ketamine could produce more patients' satisfaction than the other regimens during colonoscopy [12] . The data regarding the safety of the combination of propofol and ketamine as well as the propofol alone for colonoscopy are limited, and there are no large prospective studies that report the safety.…”

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

“…It crosses the blood-brain barrier rapidly and ensures good analgesia while maintaining airway patency, ventilation, and cardiovascular stability [21]. Nevertheless, ketamine was used only in 2 earlier studies for premedication and in a recent study in combination with propofol in adult colonoscopy [22][23][24].…”