Comparison of the Sedative Effect of Ketamine with Propofol in Patients Undergoing Colonoscopy: A Randomized Clinical Trial

Document Type : Original Article(s)

Authors

1 Professor of Anesthesiology, Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Assistant Professor of Anesthesiology, Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Associate Professor of Anesthesiology, Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Medical Student, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Abstract

Background: To perform colonoscopy as a diagnostic and therapeutic method, short-term, appropriate, and sufficient sedation is needed. Conscious sedation is a state that allows the patient to tolerate an invasive procedure while maintaining cardiac and respiratory function. This study aimed to compare the sedative effect of ketamine with propofol in patients undergoing colonoscopy.
Methods: The present study was conducted as a clinical trial on patients referred to the colonoscopy department of Imam Khomeini Hospital in Ahvaz, and the patients were divided into two groups. For one group, intravenous lidocaine 2% 1.5 mg/kg, fentanyl 1 µg/kg, and ketamine 0.5 mg/kg were prescribed, and for the other group, intravenous lidocaine 2% 1.5 mg/kg, fentanyl 1 µg/kg, and propofol 0.5 mg/kg were prescribed. Then, hemodynamic changes, degree of sedation, and pain score were checked for both groups.
Findings: There was no significant difference between age, gender, and weight in the two groups (P > 0.05). Mean arterial blood pressure, pain, and recovery time decreased in both groups, and sedation improved, but no significant difference was observed between these variables. In the ketamine group, the percentage of arterial blood oxygen saturation and pain after sedation decreased in all minutes compared to before, but no substantial difference was observed (P > 0.05). In the propofol group, there was a significant difference between the heart rate before and after sedation in all minutes (P < 0.05).
Conclusion: Both methods are associated with minimal hemodynamic changes, sedation, and adequate analgesia and can be used for effective sedation in patients.

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References

  1. Emadian O, Torabizadeh Z, Taheri H. Epidemiologic, Colonoscopic and Histologic Characteristics of Colorectal Polyps [in Persian]. J Mazandaran Univ Med Sci 2016; 25(134): 242-50.
  2. Cohen S, Glatstein MM, Scolnik D, Rom L, Yaron A, Otremski S, et al. Propofol for pediatric colonoscopy: the experience of a large, tertiary care pediatric hospital. Am J Ther 2014; 21(6): 509-11.
  3. Sonnenberg A. Sedation in Colonoscopy. Gastroenterol Hepatol (N Y). 2016; 12(5): 327-9.
  4. Childers RE, Williams L, Sonnenberg A. Practice patterns of sedation for colonoscopy. Gastrointest Endosc 2015; 82(3): 503-11.
  5. Dossa Fahima, Catherine Dubé. Practice recommendations for the use of sedation in routine hospital-based colonoscopy. BMJ Open Gastroenterol 2020; 7(1): e000348.
  6. Early DS, Lightdale JR, Vargo JJ, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87(2): 327–37.
  7. Chen Mengmeng, Yi Lu. The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study. BMC Anesthesiol 2020; 20(1): 132.
  8. Canpolat DG, Yildirim MD, Kutuk N, Dogruel F, Ocak H, Aksu R, et al. Comparison of ketamine-propofol and ketamine-dexmedetomidine combinations in children for sedation during tooth extraction. J Pak Med Assoc 2017; 67(5): 693-7.
  9. Kim EH, Park JC, Shin SK, Lee YC, Lee SK. Effect of the midazolam addition the propofol-based sedation in esophagogastroduodenoscopy: a randomized trial. J Gastroenterol Hepatol 2018; 33(4): 894-9.
  10. Damps M, Stołtny L, Siemek-Mitela J, Lekstan A, Krzych Ł, Kucewicz-Czech E. Comparison of Propofol-Ketamine Versus Propofol-Remifentanil in Children Anaesthetized for Gastroscopy. Anaesthesiol Intensive Ther 2019; 51(4): 262-7.
  11. Narula N, Masood S, Shojaee S, McGuinness B, Sabeti S, Buchan A. Safety of propofol versus nonpropofol-based sedation in children undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract 2018; 2018: 6501215.
  12. Baykal TZ, Gulec H, Dereli N, Babayigit M, Kurtay A, Inceoz H, et al. Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients. IR J Med Sci 2016; 185: 699-704.
  13. Seleem Waseem M, Khadeja M El Hossieny. Evaluation of different sedatives for colonoscopy. Curr Drug Saf 2020; 15(1): 20-4.
  14. Dal T, Sazak H, Tunç M, Şahin S, Yılmaz A. A comparison of ketamine-midazolam and ketamine-propofol combinations used for sedation in the endobronchial ultrasound-guided transbronchial needle aspiration: a prospective, single-blind, randomized study. J Thorac Dis 2014; 6(6): 742–51.
  15. Basturk A, Artan R, Yılmaz A. Efficacy and Safety of Midazolam and Ketamine in Paediatric Upper Endoscopy. Arab J Gastroenterol 2017; 18(2): 80-2.
  16. das Neves JFNP, das Neves Araújo MMP, de Paiva Araújo F, Martins Ferreira C, Neves Duarte FB, Pace FH, et al. Colonoscopy sedation: a clinical trial comparing propofol and fentanyl with or without midazolam. Braz J Anesthesiol 2016; 66(3): 231-6.
  17. Hosseini V, Fakheri H, Zamani A, Shoopay-Juybari A, Banihashem N, Maleki I, et al. Comparison of meperidine-midazolam and propofol-fentanil sedation in patients scheduled for elective colonoscopy [in Persian]. J Mazandaran Univ Med Sci 2014; 23(108): 17-22.
  18. Matas M, Sotošek V, Kozmar A, Likić R, Sekulić A. Effect of local anesthesia with lidocaine on perioperative proinflammatory cytokine levels in plasma and cerebrospinal fluid in cerebral aneurysm patients: Study protocol for a randomized clinical trial. Medicine (Baltimore) 2019; 98(42): e17450.
  19. Yang X, Wei X, Mu Y, Li Q, Liu J. A review of the mechanism of the central analgesic effect of lidocaine. Medicine (Baltimore) 2020; 99(17): e19898.
  20. Hu S, Wang M, Li S, Zhou W, Zhang Y, Shi H, et al. Intravenous lidocaine significantly reduces the propofol dose in elderly patients undergoing gastroscopy: a randomized controlled trial. Drug Des Devel Ther 2022; 16: 2695-705.
  21. Akbulut UE, Saylan S, Sengu B, Akcali GE, Erturk E, Cakir M. A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial. Eur J Gastroenterol Hepatol. 2017; 29(1): 112–8.
  22. Nazemroaya B, Honarmand A, Hashemi-Fesharaki S. Comparison of the effect of propofol-remifentanil versus propofol-ketamine on hemodynamic change and seizure duration in electroconvulsive therapy [in Persian]. J Isfahan Med Sch 2019;37(532): 728-35.
  23. Moshiri E, Modir H, Navabi M, Naziri M. Comparison effect of ketamin-propofol versus alfentanil-propofol for creating analgesia and sedation during cystoscopy [in Persian]. J Arak Uni Med Sci 2014; 17(1): 76-83.
  24. Akhondzadeh R, Ghomeishi A, Nesioonpour S, Nourizade S. A comparison between the effects of propofol–fentanyl with propofol–ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room. Biomed J 2016; 39(2): 145-9.
  25. Alatise OI, Owojuyigbe AM, Yakubu MA, Agbakwuru AE, Faponle AF. Propofol versus traditional sedative methods for colonoscopy in a low-resource setting. Niger Postgrad Med J 2015; 22(3): 151-7.
  26. Saylan S, Akbulut UE. A comparison of ketamine-midazolam combination and propofol-fentanyl combination on procedure comfort and recovery process in pediatric colonoscopy procedures. Pak J Med Sci 2021; 37(2): 483–8.
Journal of Isfahan Medical School
Volume 42, Issue 798
2nd Week, March
March and April 2025
Pages 1164-1173

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History

  • Receive Date: 03 April 2024
  • Accept Date: 30 November 2024

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