The Efficacy of Etomidate-Fentanyl versus Dexmedetomidine-Ketamine for Procedural Sedation and Analgesia during Upper Endoscopy and Biopsy: A Prospective, Randomized Study

Abstract

Objective: To assess the effectiveness of a combination of etomidate-fentanyl versus dexmedetomidineketamine for Procedural Sedation and Analgesia (PSA) in patients undergoing upper endoscopy and biopsy. Patients and methods: This is a prospective randomized observer-blinded study. This study was carried out in Tanta university hospital on 100 patients of both sexes; ASA physical status I and II, age range from 20-60 years undergone upper endoscopy and biopsy. All patients were randomly divided into two groups (each group 50 patients) Group E (etofen): patients received an initial IV bolus dose of etomidate 0.15 mg/kg + fentanyl 1 mcg/kg IV, followed by etomidate infusion at 0.01-0.03 mg/kg/min. Group D (dexmedetomidine-ketamine): patients received an initial IV bolus dose of dexmedetomidine (1 μg/kg) +ketamine (1 mg/kg) followed by dexmedetomidine infusion (0.5-1 μg/kg/hr) with supplemental bolus doses of ketamine (0.5 mg/kg) as needed. Sedation started and adjusted according to bispectral index level (BIS) range 60-80. Patients were then observed by an anesthesiologist who was blinded about sedative/analgesic received. The primary outcomes were onset, level and time of sedation and the secondary outcomes were recovery time, Length of recovery room (RR) stay (min), duration of hospital stay, VAS score, hemodynamic changes (HR, MBP, SPO 2 , RR), surgeon satisfaction, side effects, and patient satisfaction. Results: There was significant rapid onset of sedation in group E as compared to group D, Sedation level by BIS, showed significant increase (P<0.05) in group E in comparison with group D. Recovery time, Length of recovery room (RR) stay (min) and Length of hospital stay (hr) showed significant decrease (P<0.05) in group E in comparison with group D. Conclusion: The etomidate/fentanyl combination provides an effective and safe procedural sedation and analgesia for upper endoscope and biopsy. Etomidate/Fentanyl combination provides shorter sedation times and lighter sedation level (but enough for the procedure) when compared to the dexmedetomidine/ketamine combination. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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“…The findings of our study are consistent with the findings of many previous studies [35][36][37][38][39] that compared the effects of dexmedetomidine in combination with other drugs to assess the efficacy of sedation, hemodynamic stability, recovery criteria, and satisfaction scores for patients scheduled for GIE procedures, which revealed that the combination dexmedetomidine group outperformed the other combinations in terms of sedation efficacy and safety, hemodynamic stability, recovery criteria, analgesia, and satisfaction scores. However, other studies conducted by [40][41][42][43][44] revealed inefficacy of sedation scores and the need for higher doses of adjuvant drugs to achieve the target level of sedation with less hemodynamic stability and poor recovery criteria.…”

Bispectral Index (Bis) Guided Comparison Between Clinical Effects of Etomidate and Fentanyl Versus Dexmedetomidine and Fentanyl for Conscious Sedation in Ercp Procedure

“…Thus, it was found that etomidate-fentanyl combination resulted in earlier onset and shorter duration of sedation, consistent with the study carried out by El-Shmaa NS and El-Baradey GF in the year 2014. [15] Possible reasons behind the above results are [16]  Short initial distribution half-life of etomidate.…”

Review on Commonly Used Veterinary Anesthetic Drugs in Small Ruminants

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