Effect of Ketamine and Fentanyl in Combination with Midazolam and Propofol during Outpatient Colonoscopy-A Randomised Controlled Trial
Published: September 1, 2018 | DOI: https://doi.org/10.7860/JCDR/2018/25815.12053
Madhusudan Upadya, S Neeta, Gagan Brar, Anand Kulkarni, Jose Chacko
1. Professor, Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, India.
2. Associate Professor, Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, India.
3. Registrar, Department of Anaesthesiology, MICU, Fortis Hospital, Bengaluru (Formerly Senior Resident), Kasturba Medical College, Mangalore, India.
4. Consultant, Department of Anaesthesiology, RIPAS Hospital, Brunei Darussalam (Formerly Associate Professor), Kasturba Medical College, Mangalore, Manipal University, India.
5. Senior Consultant DNB, EDIC, Department of Anaesthesiology, Narayana Hrudayalaya, Bengaluru, India.
Correspondence
Dr. Madhusudan Upadya,
MD, Professor of Anaesthesiology, Kasturba Medical College Hospital, Attavar, Mangalore-575001,
Mangalore, Manipal University, India.
E-mail: madhusudan.upadya@manipal.edu
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 20µg/kg, propofol and fentanyl 2µg/kg. Group II (n=30) (Ketamine group) was assigned to receive midazolam 20µg/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 (18.3±2.7 seconds Vs 22.4±2.2 seconds). Patients belonging to the ketamine group had a significantly shorter recovery time compared to those in the fentanyl group (5.8±1.4 Vs 8.0±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 “propofol sparing” effect.
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