engleski

Comparison of propofol versus propofol and ketamine for deep sedation during endoscopic retrograde cholangiopancreatography in elderly patients

Background and Goal of Study: Propofol is frequently used in anesthesiologist- administered deep sedation for endoscopic retrograde cholangiopancreatography (ERCP). Sedation-related adverse events (SRAEs), associated with propofol administration, include hypotension, arrhythmia, O2 desaturation (< 85%), unplanned intubation and procedure termination (1). The aim of this study was to evaluate the efficacy of synergistic effect of small dose of ketamine (25 mg) and propofol in comparison with propofol alone on propofol consumption and SRAEs during target-controlled propofol infusion (TCI) for deep sedation in elderly patients (>65 years) undergoing ERCP. Materials and Methods: In this prospective, double blind study of 40 unpremedicated elderly patients (> 65 years) undergoing ERCP, induction and maintenance was established by TCI pump (Schnider model) for propofol alone in Group P (N=20) or by propofol and bolus dose of 25 mg of ketamine administered after losing ciliary reflex in Group PK (N=20). Propofol target blood concentration of 5.0 µg/mL was used for induction and 2-4 µg/ ml for maintenance of deep sedation in both groups. SRAEs, the total dose of administered propofol (mg) and the mean duration of ERCP (min) were recorded. Data are expressed as means ± SD or frequencies as appropriate. Student’s t-test and Chi-square with Yates’correction were used. Results and Discussion: Patients in both groups were comparable in terms of BMI, ASA status and duration of ERCP. The mean age in Group P was 74, 65±4, 3 and in Group PK 75±4, 5. There was statistically significant difference in propofol consumption (Group P 380, 1 ± 135, 4 ; Group PK 352, 65 ±109, 44, p=0, 0004). Incidence of hypotension was 30% in Group P and none in Group PK and difference reached statistical significance (p=0, 0268). There was no significant difference among other SRAEs between groups. Conclusion(s): There is efficacy of synergistic effect of small dose of ketamine and propofol on lower propofol consumption and lower incidence of hypotension whereas incidence of other SRAEs was not observed between the groups.

ERCP ; propofol ; ketamine

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