संज्ञानश्वासन और निदान शोध जर्नल
खुला एक्सेस

अमूर्त

Propofol vs. Ketofol for Endoscopic Retrograde Cholangiopancreatography (ERCP) Bi-Spectral Index (BIS) Guided Sedation: A Randomized Clinical Trial

Eman Sayed Ibrahim, Emad Kamel Refaat, Alaa Eldin Abd Elsami Aiad, Eman Ahmed Fathy and Osama Abdullah EL Sharkawy

Objective: Sedation for ERCP with propofol related adverse events (SRAES) includes hypotension, arrhythmia, oxygen desaturation, unplanned intubation and procedure termination. The aim of this study was to evaluate the effect of adding a small synergistic dose of ketamine to propofol (Ketofol) vs. propofol alone.

Methods: 80 adults (ASAI-II) scheduled for elective ERCP categorized into Ketofol (KP) (n=40) and Propofol (P) (n=40) groups. In Propofol (P) group, 1.5 mg/kg over 3-5 min then 50-75 mic/kg/min guided by BIS (≥60). In KP group: 1.5 ml/kg of (Propofol 1%+Ketamine (50 mg)+4 ml normal saline) over 3-5 min then 50-75 mic/kg/min. Nasal airway after sedation. Induction and recovery time, Propofol consumption, haemodynamics, pain assessment, nausea and vomiting were recorded post-operative.

Results: Total dose of propofol consumption was significantly higher in group P compared with group KP (39.63 ± 13.66 vs. 28.23 ± 7.89 mg; P=0.00). Induction time: was (5.12 ± 0.85 vs. 7.15 ± 1.23 min; P=0.00) and recovery time (Guided by BIS): was (6.25 ± 0.90 vs. 9.25 ± 2.17 min; P=0.00) for P and KP group respectively and there were statistically significant prolongation in both times in KP group. Sedation with Propofol only increased the depth of sedation (BIS) during endoscopy compared to Ketofol, p<0.001. No difference between both groups in the incidence of agitation p=0.239, pain p=0.124, nausea and vomiting p=0.230, hypotension p=1, and desaturation p=0.671.

Conclusion: Despite the ability of Ketamine to a reduce propofol consumption a prolongation in induction time and recovery times with Ketofol was noticed. The effect of ketamine on BIS readings need to be further investigated.