Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)

Algharabawy, Wael Sayed; Abusinna, Rasha Gamal; Abdelrahman, Tamer Nabil

doi:10.1080/11101849.2021.1961428

Cited by 7 publications

(11 citation statements)

References 42 publications

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“…Seven studies ( Algharabawy et al, 2021 ; Aminnejad et al, 2022 ; Koksal et al, 2014 ; B. S. Lee et al, 2014 ; Lu et al, 2018 ; Wu et al, 2014 ; Yin et al, 2019 ) reported the RSS score of patients, with 369 patients in the control group vs. 389 patients in the DEX group. There was no significant difference between the DEX group and the control group in RSS score of patients (WMD: 0.34; 95% CI: −0.04 to 0.72; p = 0.08; I 2 = 96%) ( Figure 2A ).…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies ( Kilic et al, 2011 ; Takimoto et al, 2011 ; Eldesuky Ali Hassan, 2015 ; Lee et al, 2015 ; Wu et al, 2015 ; Goyal et al, 2016 ; Lu et al, 2018 ; Srivastava et al, 2018 ; Pushkarna et al, 2019 ; Yin et al, 2019 ; Algharabawy et al, 2021 ) recorded the prevalence of body movements or gagging, with 567 patients in the control group vs. 587 patients in the DEX group. The prevalence of body movements or gagging was significantly decreased in the DEX group (RR: 0.60; 95% CI: 0.37 to 0.97; p = 0.04; I 2 = 68%) compared with the control group ( Figure 2B ).…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies ( Demiraran et al, 2007 ; Takimoto et al, 2011 ; Mazanikov et al, 2013 ; Koksal et al, 2014 ; Lee et al, 2014 ; Cheung et al, 2015 ; Eldesuky Ali Hassan, 2015 ; Lee et al, 2015 ; Mukhopadhyay et al, 2015 ; Wu et al, 2015 ; Goyal et al, 2016 ; Kinugasa et al, 2018 ; Lu et al, 2018 ; Nonaka et al, 2018 ; Yin et al, 2019 ; Ahmed et al, 2020 ; Algharabawy et al, 2021 ; Ashikari et al, 2021 ) reported data concerning the risk of hypoxia, which was observed in 748 patients in the control group and 767 patients in the DEX group. The risk of hypoxia was significantly decreased in the DEX group (RR:0.34; 95% CI: 0.20 to 0.55; p < 0.0001; I 2 = 52%) compared with the control group ( Figure 4B ).…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies ( Jalowiecki et al, 2005a ; Takimoto et al, 2011 ; Vázquez-Reta et al, 2011 ; Mazanikov et al, 2013 ; Lee et al, 2014 ; Samson et al, 2014 ; Lee et al, 2015 ; Goyal et al, 2016 ; Karanth et al, 2018 ; Kinugasa et al, 2018 ; Nonaka et al, 2018 ; Srivastava et al, 2018 ; Yin et al, 2019 ; Ahmed et al, 2020 ; Koruk et al, 2020 ; Algharabawy et al, 2021 ; Ashikari et al, 2021 ; Aminnejad et al, 2022 ; Chen et al, 2022 ) recorded the risk of hypotension, with 787 patients in the control group vs. 776 patients in the DEX group. There was no significant difference in risk of hypotension between the DEX group (RR: 1.31; 95% CI: 0.85 to 2.02; p = 0.22; I 2 = 61%) and the control group ( Figure 5A ).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Tang,

Huang,

Zhang

et al. 2023

Front. Pharmacol.

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Background: The sedative role of dexmedetomidine (DEX) in gastrointestinal endoscopic procedures is unclear. We performed this systematic review and meta-analysis to assess the efficacy and safety of sedation with DEX during gastrointestinal endoscopic procedures with a view to providing evidence-based references for clinical decision-making.Methods: The PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) that compared DEX with different sedatives comparators (such as propofol, midazolam, and ketamine) for sedation in a variety of adult gastrointestinal endoscopic procedures from inception to 1 July 2022. Standardized mean difference (SMD) and weighted mean difference (WMD) with 95% confidence interval (CI) or pooled risk ratios (RR) with 95% CI were used for continuous outcomes or dichotomous outcomes, respectively, and a random-effect model was selected regardless of the significance of the heterogeneity.Results: Forty studies with 2,955 patients were assessed, of which 1,333 patients were in the DEX group and 1,622 patients were in the control (without DEX) group. The results suggested that the primary outcomes of sedation level of DEX are comparable to other sedatives, with similar RSS score and patient satisfaction level, and better in some clinical outcomes, with a reduced risk of body movements or gagging (RR: 0.60; 95% CI: 0.37 to 0.97; p = 0.04; I2 = 68%), and a reduced additional requirement for other sedatives, and increased endoscopist satisfaction level (SMD: 0.41; 95% CI: 0.05 to 0.77; p = 0.03; I2 = 86%). In terms of secondary outcomes of adverse events, DEX may benefit patients in some clinical outcomes, with a reduced risk of hypoxia (RR:0.34; 95% CI: 0.20 to 0.55; p < 0.0001; I2 = 52%) and cough (RR: 0.25; 95% CI: 0.12 to 0.54; p = 0.0004; I2 = 0%), no significant difference in the risk of hypotension, while an increased risk of bradycardia (RR: 3.08; 95% CI: 2.12 to 4.48; p < 0.00001; I2 = 6%).Conclusion: This meta-analysis indicates that DEX is a safe and effective sedative agent for gastrointestinal endoscopy because of its benefits for patients in some clinical outcomes. Remarkably, DEX is comparable to midazolam and propofol in terms of sedation level. In conclusion, DEX provides an additional option in sedation for gastrointestinal endoscopic procedures.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#searchadvanced

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Tang,

Huang,

Zhang

et al. 2023

Front. Pharmacol.

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“…Dexmedetomidine decreases HR by decreasing norepinephrine levels [25]. A decrease in HR with dexmedetomidine was observed in many studies [6,7,16,21,22]. The studies by Canpolat et al and Mogahd et al showed no significance concerning changes in HR [9,26].…”

Section: Hemodynamic Parametersmentioning

confidence: 94%

Intravenous Dexmedetomidine-Ketamine Versus Ketamine-Propofol for Procedural Sedation in Adults Undergoing Short Surgical Procedures: A Randomized Controlled Trial

Kakarla,

Senapati,

Das

et al. 2023

Cureus

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Background and objectiveModerate to deep sedation is a prerequisite during total intravenous anesthesia for short-duration surgeries, and it can be achieved by using individual drugs or in combination. Our study compared dexmedetomidineketamine (DK) versus ketamine-propofol (KP) in terms of sedation, procedural interference, hemodynamics, and incidence of side effects in patients undergoing short surgical procedures. MethodsA total of 194 patients scheduled for short-duration elective surgeries were randomly allocated into two groups. Group DK received a loading dose of 1 µg/kg of dexmedetomidine and 1 mg/kg of ketamine followed by a maintenance infusion of dexmedetomidine at 0.3 µg/kg/h. Group KP received a loading dose of 1 mg/kg of ketamine and 1 mg/kg of propofol followed by a maintenance infusion of propofol at 25 µg/kg/h. For procedural interference, a rescue ketamine bolus was administered at 0.25 mg/kg. Patients were monitored for the requirement of rescue ketamine bolus, procedural interference, hemodynamics, sedation, recovery time, and adverse effects. ResultsThe procedural interference was higher in group KP than in group DK and the difference was statistically significant (P=0.001). The time to the first rescue bolus was 8.72 ± 4.47 minutes in group KP and 10.82 ± 4.01 minutes in group DK, with a difference of 2.1 minutes (p=0.026). There was no statistically significant difference in the sedation scores between both groups except at time points of six minutes and 15 minutes. ConclusionFor short-duration procedures, the DK combination is superior to the KP combination in terms of procedural interference and time to the first rescue bolus, while both groups were comparable with regard to safety and hemodynamics.

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Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis

Elsaeidy,

Ahmad,

Kohaf

et al. 2024

Curr Pain Headache Rep

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Purpose of Review The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients. Methods We searched PubMed, CENTRAL, Web of Science, and Scopus from inception to August 1, 2023. Our outcome parameters for efficacy were recovery time, pain score, and physician satisfaction while for safety were the related cardiorespiratory, neurological, and gastrointestinal adverse events. Recent Findings Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I2 = 94%) and a significantly less pain score of − 0.72 (95% CI, − 1.10, − 0.34; I2 = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I2 = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I2 = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I2 = 15%). Summary Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.

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Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)

Abstract: Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study), Egyptian

Cited by 7 publications

References 42 publications

Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Intravenous Dexmedetomidine-Ketamine Versus Ketamine-Propofol for Procedural Sedation in Adults Undergoing Short Surgical Procedures: A Randomized Controlled Trial

Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis

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