A Comparison of Dexmedetomidine with Ketamine (DEXKET) and Propofol with Ketamine (KETOFOL) During Endoscopic Retrograde Cholangiopancreatography
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/009Keywords:
Dexmedetomidine, Ketamine, Sedation, Oxygen Saturation, PropofolAbstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) requires safe and effective sedation to maintain patient comfort and procedural safety. Ketamine-propofol (KetoFol) is commonly used, but risks of desaturation and delayed recovery remain. Dexmedetomidine combined with ketamine (DexKet) offers stable sedation with minimal respiratory depression. Comparative local evidence of these two combinations in ERCP patients is limited.
Methods: This randomized controlled trial was conducted at the Endoscopy Department, Patel Hospital, Karachi. A total of 110 patients aged 18–60 years undergoing ERCP were randomly allocated into two groups: Group A received KetoFol, and Group B received DexKet. Oxygen saturation (SpO₂), vital signs, and Ramsay sedation scores were recorded during the procedure and recovery. Data were analyzed using appropriate statistical tests, with a p-value <0.05 considered significant.
Results: Group B (DexKet) demonstrated significantly higher mean SpO₂ compared to Group A (97.5% vs. 93.2%, p<0.001) with more stable hemodynamics. At 10 minutes, deeper sedation was observed in Group B (Ramsay score 5.18 vs. 3.35), while recovery was faster at 30 minutes (2.03 vs. 5.09).
Conclusion: DexKet provided superior oxygenation, more stable sedation, and quicker recovery compared to KetoFol during ERCP. This suggests DexKet as a safer and more effective alternative for procedural sedation. Further multicenter trials are recommended to confirm its wider clinical applicability.
References
1. Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology. 2005;129:1384–91.
2. Goudra BG, Singh PM, Sinha AC. Outpatient endoscopic retrograde cholangiopancreatography: Safety and efficacy of anesthetic management with a natural airway in 653 consecutive procedures. Saudi J Anaesth. 2013;7:259–65.
3. Rodriguez H. J., Ghassemi K., Vesga L., Verma R. V., Bagatelos K. C., Ostroff J. W. Changes in sedation trends for ERCP before and after the droperidol black box warning. Gastrointestinal Endoscopy. 2006;63(5):p. AB307.
4. Early D. S., Lightdale J. R., Vargo J. J., et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy. 2018;87(2):327–337.
5. Raymondos K., Panning B., Bachem I., Manns M. P., Piepenbrock S., Meier P. N. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy. 2002;34(9):721–726.
6. Guidelines for sedation and/or analgesia for diagnostic and interventional medical, dental and surgical procedures(2014)
7. Venn RM, Hell J, Michael Grounds R. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Critical Care. 2000 Oct;4:1-7.
8. Algharabawy WS, Abusinna RG, AbdElrahman TN. Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study). Egyptian J Anaesthesia. 2021 Jan 1;37(1):364-72.
9. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93(2):382–94.
10. Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18(4):412–8.
11. Goyal R, Shukla RN, Kumar S, Tripathi S. Comparison of dexmedetomidine and propofol infusion for sedation during awake fiberoptic intubation: a prospective, randomized, double-blind study. J Anaesthesiol Clin Pharmacol. 2013;29(4):506–10.
12. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;96(2):999–1005.
13. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90(3):699–705.
14. Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdziak P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology. 2005;103(2):183–8.
15. Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, et al. The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic. Anesth Analg. 2003;96(6):1719–23.
16. Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008;106(1):174–9.
17. Gerlach AT, Dasta JF. Dexmedetomidine: an updated review. Ann Pharmacother. 2007;41(2):245–52.
18. Bharti N, Chari P. Epidural butorphanol–bupivacaine analgesia for postoperative pain relief after abdominal hysterectomy. J Clin Anesth. 2009;21(1):19–22.
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