Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial
Fakhroddin Bahrami Gorji, Parviz Amri, Javad Shokri, Hakimeh Alereza, Ali Bijani, Fakhroddin Bahrami Gorji, Parviz Amri, Javad Shokri, Hakimeh Alereza, Ali Bijani
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.
Objectives: In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.
Methods: In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.
Results: The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).
Conclusions: The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.
Keywords: Analgesia; Fentanyl; Ketamine; Midazolam; Propofol; Sedation.
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References
- Smith A, Silvestro L, Rodriguez RE, Austin PN. Evidence-Based Selection of Sedation Agents for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography. Gastroenterol Nurs. 2016;39(1):32–41. doi: 10.1097/SGA.0000000000000195.
- Hasanein R, El-Sayed W. Ketamine/propofol versus fentanyl/propofol for sedating obese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Egypt J Anaesth. 2013;29(3):207–11. doi: 10.1016/j.egja.2013.02.009.
- Abdalla MW, El Shal SM, El Sombaty AI, Abdalla NM, Zeedan RB. Propofol dexmedetomidine versus propofol ketamine for anesthesia of endoscopic retrograde cholangiopancreatography (ERCP) (A randomized comparative study). Egyptian J Anaethesia. 2015;31(2):97–105. doi: 10.1016/j.egja.2014.12.008.
- Yang JF, Farooq P, Zwilling K, Patel D, Siddiqui AA. Efficacy and Safety of Propofol-Mediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP). Dig Dis Sci. 2016;61(6):1686–91. doi: 10.1007/s10620-016-4043-3.
- Imani F, Safari S. "Pain Relief is an Essential Human Right", We Should be Concerned about It. Anesth Pain Med. 2011;1(2):55–7. doi: 10.5812/kowsar.22287523.2306.
- Imani F. Postoperative pain management. Anesth Pain Med. 2011;1(1):6–7. doi: 10.5812/kowsar.22287523.1810.
- Griffiths RD, Jones C. ABC of intensive care: Recovery from intensive care. Bmj. 1999;319(7207):427–9. doi: 10.1136/bmj.319.7207.427.
- Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89–91.
- Ahmadi A, Amri P, Shokri J, Hajian K. Comparison of the analgesic effect of intravenous paracetamol/midazolam and fentanyl in preparation of patients for colonoscopy: A double blind randomized clinical trial. Caspian J Intern Med. 2015;6(2):87–92.
- Singh Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl. Saudi J Anaesth. 2010;4(2):72–9. doi: 10.4103/1658-354X.65132.
- Fabbri LP, Nucera M, Marsili M, Al Malyan M, Becchi C. Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: is ketamine not only a "rescue drug"? Med Sci Monit. 2012;18(9):575–80.
- Arora S. Combining ketamine and propofol ("ketofol") for emergency department procedural sedation and analgesia: a review. West J Emerg Med. 2008;9(1):20–3.
- Godambe SA, Elliot V, Matheny D, Pershad J. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics. 2003;112(1 Pt 1):116–23.
- Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, et al. Asge Standards of Practice Committee.. Complications of ERCP. Gastrointest Endosc. 2012;75(3):467–73. doi: 10.1016/j.gie.2011.07.010.
- 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(3):259–65. doi: 10.4103/1658-354X.115334.
- Aydogan H, Aydogan T, Uyankoglu A, Kucuk A, Yuce HH, Karahan MA, et al. Propofol-ketamine combination has shorter recovery times with similar hemodynamics compared to propofol alone in upper gastrointestinal endoscopy in adults: a randomized trial. Acta Med Okayama. 2013;29:259–64.
- Smischney NJ, Beach ML, Loftus RW, Dodds TM, Koff MD. Ketamine/propofol admixture (ketofol) is associated with improved hemodynamics as an induction agent: a randomized, controlled trial. J Trauma Acute Care Surg. 2012;73(1):94–101. doi: 10.1097/TA.0b013e318250cdb8.
- Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr. 2012;54(3):422–6. doi: 10.1097/MPG.0b013e3182323c75.
- Ramkiran S, Iyer SS, Dharmavaram S, Mohan CVR, Balekudru A, Kunnavil R. BIS Targeted Propofol Sparing Effects of Dexmedetomidine Versus Ketamine in Outpatient ERCP: A Prospective Randomised Controlled Trial. J Clin Diagn Res. 2015;9(5):07–12.
- Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth. 2007;17(10):983–8. doi: 10.1111/j.1460-9592.2007.02206.x.
- Gilger MA, Spearman RS, Dietrich CL, Spearman G, Wilsey MJ, Zayat MN. Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy. Gastrointest Endosc. 2004;59(6):659–63.
- Willman EV, Andolfatto G. A prospective evaluation of "ketofol" (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007;49(1):23–30. doi: 10.1016/j.annemergmed.2006.08.002.
- Badrinath S, Avramov MN, Shadrick M, Witt TR, Ivankovich AD. The use of a ketamine-propofol combination during monitored anesthesia care. Anesth Analg. 2000;90(4):858–62.
- Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr. 2001;32(1):26–33.
Source: PubMed