Evaluation of anesthesia quality with three methods: “propofol + fentanyl” vs. “propofol + fentanyl + lidocaine” vs. “propofol + fentanyl + lidocaine + ketamine” in patients referred to the scoping ward

Rafiei, M R; Edalatkhah, Sepehr; Hazrati, Ebrahim; Hashemi, Mahmoodreza; Golaghaei, Alireza; Kheradmand, Behroz

doi:10.4103/jfmpc.jfmpc_1387_21

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…It is crucial to note that in the Aminnejad et al study, the effects of KET were evaluated in conjunction with dexmedetomidine, rather than propofol, as in our investigation. Edalatkhah et al, in comparing 3 drug combinations for anesthesia for colonoscopy, showed that the use of propofol with FNT, KET, and LID was associated with a lower incidence of respiratory events (cough, apnea, need for jaw thrust) than was the use of propofol with FNT or propofol with FNT and LID [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

Chudziński,

Szułdrzyński,

Jankowski

et al. 2024

Med Sci Monit

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Background Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. Material/Methods In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). Results Patients administered fentanyl needed significantly more propofol ( P =0.017) than those on ketamine, with lidocaine showing no notable difference ( P =0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group ( P <0.001). The ketamine group experienced milder reductions in mean arterial ( P =0.018) and systolic blood pressure ( P <0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl ( P <0.001 ) , although satisfaction and pain levels were consistent across all groups ( P =0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P =0.018) and ketamine (15.1%, P =0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P =0.04) than fentanyl group. Conclusions Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

Chudziński,

Szułdrzyński,

Jankowski

et al. 2024

Med Sci Monit

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Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection

Zhang¹,

Chen²,

Liu³

et al. 2022

Journal of Oncology

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Endoscopic submucosal dissection (ESD) is a minimally invasive technique to completely peel the pathological mucosa from the submucosa under endoscopy, which has been often utilized to treat early gastric cancer. During the operation, anesthesia is required to reduce the discomfort due to the complexity, high risk, and longtime operation of ESD. In this study, we compared different anesthesia methods on anesthetic effect and postoperative pain in patients (≥65 years old) with early gastric cancer during ESD. For this purpose, 60 patients with early gastric cancer who were more than 65 years old were selected from January 2019 to December 2021, where 30 patients treated with simple intravenous general anesthesia were divided into the simple group and 30 patients treated with intravenous combined inhalation general anesthesia were regarded as the composite group. The hemodynamic index, wake-up time, postoperative pain intensity, operation time, and the incidence of adverse reactions were compared between the two groups. For the hemodynamic index before incision, after incision, and at the end of the operation, the mean arterial pressure (MAP) in the composite group was higher than that in the simple group P < 0.05 and the heart rate (HR) was lower than that in the simple group P < 0.05 . After the ESD operation, the wake-up time and visual analogue scale (VAS) in the composite group were lower than those in the simple group P < 0.05 . In addition, the ESD operation time and incidence of adverse reactions in the composite group was significantly lower than that in the simple group P < 0.05 . These results showed that intravenous combined inhalation general anesthesia had a good anesthetic effect, stable hemodynamics during ESD operation, and slight postoperative pain.

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Risk Factors for Adverse Reactions to Nurse-Administered Propofol During Outpatient Endoscopy: A Cross-Sectional Study

Inca,

Montero,

Montachez

et al. 2024

Preprint

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Background Endoscopic procedures are essential for diagnosing and managing gastrointestinal conditions, often requiring sedation for patient comfort. Propofol is a common choice for outpatient sedation due to its rapid onset and predictable recovery time. Although propofol has an established safety profile, adverse drug reactions (ADRs) can still occur. This study investigated the prevalence and risk factors associated with ADRs related to nurse-administered propofol sedation during outpatient endoscopic procedures at a private hospital in Peru. Method We conducted a retrospective study. The clinical records of 919 Peruvian patients who underwent endoscopic interventions under propofol sedation were reviewed. This study included patients between the ages of 18 and 69 years who had American Society of Anesthesiologists (ASA) physical status classification scores of I–III and who were hemodynamically stable with an oxygen saturation (SO2) > 90% before the procedure. Sedation was nurse-administered using standardized protocols. ADR data, including severity and causality assessment data, were collected. Data were collected and analyzed by SPSS, Inc., and the statistical significance was calculated at the p < 0.05 level. Results A total of 693 patients were included in the study, 30.9% of whom experienced at least one ADR, predominantly cardiovascular or respiratory events such as hypotension and hypoxia, with causality scores classified as probable or definitive. Among the ADRs, 35.8% (n = 87) were moderately severe, and 64.2% (n = 143) were mildly severe. There were no reports of any serious adverse events. An ASA class III status (p = 0.048, PR adjusted (PRa) = 1.73, 95% CI: 1.01–2.99) and a procedure time of more than 20 minutes (p < 0.0001, PRa = 2.05, and 95% CI: 1.53–2.73) were significant risk factors for ADR occurrence. Patients with ADRs had longer recovery times than did those without ADRs (22 min ± 22.5 vs 14 min ± 8, respectively; p < 0.001). Conclusion In our work, moderate propofol sedation administered by trained nursing staff to outpatients undergoing interventional endoscopic procedures was generally safe but not free from risks. Vital parameters should be monitored regularly during long-term interventions and when patients are classified as ASA III.

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Evaluation of anesthesia quality with three methods: “propofol + fentanyl” vs. “propofol + fentanyl + lidocaine” vs. “propofol + fentanyl + lidocaine + ketamine” in patients referred to the scoping ward

Cited by 3 publications

References 23 publications

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection

Risk Factors for Adverse Reactions to Nurse-Administered Propofol During Outpatient Endoscopy: A Cross-Sectional Study

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