Effect of Ketamine and Fentanyl in Combination with Midazolam and Propofol during Outpatient Colonoscopy-A Randomised Controlled Trial UC05-UC09
Dr. Madhusudan Upadya,
MD, Professor of Anaesthesiology, Kasturba Medical College Hospital, Attavar, Mangalore-575001,
Mangalore, Manipal University, India.
Introduction: There are various methods for sedation in colonoscopy and ketamine has been found to be an effective alternative drug for sedation.
Aim: To compare the efficacy and haemodynamic stability of lower dose of ketamine and fentanyl co-administered with midazolam and propofol for colonoscopy.
Materials and Methods: Sixty American Society of Anaesthesiologists (ASA) I-II patients undergoing colonoscopy were randomised into two groups. Group I (n=30) (Fentanyl group) was assigned to receive midazolam 20Âµg/kg, propofol and fentanyl 2Âµg/kg. Group II (n=30) (Ketamine group) was assigned to receive midazolam 20Âµg/kg, propofol and ketamine 0.5mg/kg. The parameters measured include haemodynamic stability, recovery, pain scores and endoscopists satisfaction. All statistical analysis was carried out using Medcalc Statistical Software version 11.0 (Medcalc Software bvba, Belgium).
Results: The time to full sedation in the ketamine group was significantly less than that in the fentanyl group (18.3Â±2.7 seconds Vs 22.4Â±2.2 seconds). Patients belonging to the ketamine group had a significantly shorter recovery time compared to those in the fentanyl group (5.8Â±1.4 Vs 8.0Â±1.9 minutes). Overall patient satisfaction was significantly higher with the use of ketamine. Patients were haemodynamically more stable with a lower incidence of hypotension in ketamine group.
Conclusion: The present study shows that midazolam/ketamine /propofol combination provides adequate levels of analgesia and sedation, quicker recovery and has â€śpropofol sparingâ€ť effect.