Ketamine as the main analgesic agent during analgesia-based sedation for elective colonoscopy – A randomised, double-blind, control study

Abstract

Aim: The aim of the study was to compare the analgesic effects of ketamine over fentanyl combined with propofol in analgesia-based elective colonoscopy with purpose of patient safety and satisfaction. Methods: This is a double-blinded prospective randomized controlled trial. Ninety patients were included and randomized to either fentanyl-propofol (Group FP, n : 30), ketamine-propofol (Group KP, n : 30) or propofol-control group (Group C, n : 30). Group FP patients received fentanyl and propofol, Group KP received ketamine and propofol and Group C, propofol. In all groups, incremental doses of propofol were used to maintain a Ramsay sedation score (RSS) of 5. Respiratory depression and hemodynamic parameters were monitored for the first minute and every 5 min during endoscopy. Fifteen minutes after the procedure, the degree of pain was assessed using a visual analog scale (VAS), the quality of recovery according to the Aldrete score (ARS), complications during and after the procedure and additional doses of propofol were recorded. Results: Mean arterial pressure (MAP) at 5 and 30 min ( p < 0.05), heart rate (HR) at 15, 25 and 30 min ( p < 0.05) and peripheral oxygen saturation (SpO 2 ) at 30 min ( p < 0.05) were statistically significant for Group FP. Desaturation (* p = 0.033), and weakness (* p = 0.004) was also significant for Group FP at 20, 25 and 30 min ( p < 0.05). Pain was lower assessed for the Group KP according to the VAS (** p = 0.025). Conclusion: In analgesia-based colonoscopy, ketamine provides appropriate analgesia and less incidence of complications compared to fentanyl.

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

“…Nonetheless, the clinical significance of hypotension during sedative procedures can differ from that during surgery. In contrast, a double-blind, placebo-controlled study discerned no variation in hypotension frequency when comparing KET-propofol, FNT-propofol, and propofol-only groups during colonoscopy anesthesia [ 38 ]. Similarly, a meta-analysis indicated that adjunctive i.v.…”

Comparison of patient-controlled analgesia and sedation (PCAS) with remifentanil and propofol versus total intravenous anesthesia (TIVA) with midazolam, fentanyl, and propofol for colonoscopy

“…[1] During colonoscopy, several drugs and methodologies have been used to achieve sedation and analgesia. [2][3][4][5] Among various methodologies, patient-controlled analgesia and sedation (PCAS) is a wellestablished method that provides safe and effective analgesia…”

“…[1] During colonoscopy, several drugs and methodologies have been used to achieve sedation and analgesia. [2–5] Among various methodologies, patient-controlled analgesia and sedation (PCAS) is a well-established method that provides safe and effective analgesia and sedation for individual patients according to their requirements. [6] PCAS procedure administered with a combination of propofol and alfentanil has been shown to be acceptable by patients undergoing colonoscopy.…”