Alternative sedation for the higher risk endoscopy: a randomized controlled trial of ketamine use in endoscopic retrograde cholangiopancreatography

Narayanan, Suresh; Shannon, Andrew; Nandalan, Subash; Jaitly, Varun; Greer, Sheldon

doi:10.3109/00365521.2015.1036113

Cited by 10 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ketamine is an analgesic that is most effective when used alongside a low-dose opioid; while it does have analgesic effects by itself, the doses required for adequate pain relief when it is used as the sole analgesic agent are considerably higher and far more likely to produce disorienting side effects. 16 – 19 In our study, we found that the incidence of adverse reactions were greatly increased in those injected with 1 mg/kg ketamine before anesthesia induction than those injected with butorphanol ( P <0.05). In addition, injection with ketamine combined with butorphanol before anesthesia could efficiently shorten recovery time and reduce incidence of adverse reactions than application of each drug separately.…”

Section: Discussionmentioning

confidence: 59%

Effect of ketamine combined with butorphanol on emergence agitation of postoperative patients with gastric cancer

Lin

Liu

Chen

et al. 2016

TCRM

View full text Add to dashboard Cite

BackgroundThis study aimed to investigate the effect of ketamine combined with butorphanol on emergence agitation (EA) in postoperative gastric cancer patients.Materials and methodsA total of 150 patients with gastric cancer were included and divided into group B (1 mg butorphanol before anesthesia induction, n=50), group K (1 mg/kg ketamine, n=50), and group C (1 mg butorphanol combined with 1 mg/kg ketamine, n=50). Mean arterial pressure (MAP) and heart rate (HR) at the end of operation, just before extubation (T0) and at 0 minute (T1), 5 minutes (T2), and 30 minutes (T3) after extubation were compared. Statistical analysis of recovery time, extubation time, time in postanesthesia care unit, and EA incidence and adverse reactions were performed.ResultsThere were no differences among groups with respect to MAP and HR at T0 and T1 (P>0.05). Compared with patients in group C, significant reduction of MAP and HR were observed in groups K and B at T2 and T3 (P<0.05), while no differences were found between group K and group B (P>0.05). Recovery time, extubation time, time in postanesthesia care unit, and incidence of EA in group C were significantly less than those in groups K and B (P<0.05), but no differences were observed between group K and group B (P>0.05). Total incidence of adverse reactions were significantly increased in group K compared to those in groups C and B (P<0.05).ConclusionInjection of ketamine combined with butorphanol before anesthesia induction was more effective than injection of ketamine or butorphanol separately in the prevention of EA.

show abstract

Section: Discussionmentioning

confidence: 59%

Effect of ketamine combined with butorphanol on emergence agitation of postoperative patients with gastric cancer

Lin

Liu

Chen

et al. 2016

TCRM

View full text Add to dashboard Cite

show abstract

“…This may be related to the use of higher doses of ketamine and it is dissociative effects. In a randomized controlled trial by Narayanan et al ., 28 ketamine was not found to cause emergence symptoms. In our study, the mean ketamine dose in younger patients (62 ± 23.4 mg) was more than twice the median dose (25 mg [25–37.5]) used in the study by Narayanan et al .…”

Section: Discussionmentioning

confidence: 92%

Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine

Tokmak

Çetin

Torun

2021

Geriatrics Gerontology Int

View full text Add to dashboard Cite

Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged ≥80 years (Group A) and 173 patients (193 procedures) were aged ≤65 years (Group B). We analyzed the prospectively collected data of patient‐ and procedure‐related variables. Results The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). Conclusions ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int 2021; 21: 887–892.

show abstract

“… 10 - 12 Epidural and intravenous administration of ketamine has been shown to reduce postoperative analgesic requirements by 35-40%. 13 - 16 Adding propofol to ketamine reduces the incidence of dose-dependent adverse effects on the cardiovascular and respiratory systems. 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Kilic

Demiriz

Işıkay

et al. 2016

SMJ

View full text Add to dashboard Cite

Objectives:To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP).Methods:In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded.Results:Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A.Conclusion:Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.

show abstract

Alternative sedation for the higher risk endoscopy: a randomized controlled trial of ketamine use in endoscopic retrograde cholangiopancreatography

Abstract: In this pilot study, sedation for endoscopy with ketamine and midazolam was as effective as conventional sedation, as acceptable to patients, and was not associated with dysphoric events. Ketamine may have potential as an agent for sedation in higher risk patients.

Cited by 10 publications

References 29 publications

Effect of ketamine combined with butorphanol on emergence agitation of postoperative patients with gastric cancer

Effect of ketamine combined with butorphanol on emergence agitation of postoperative patients with gastric cancer

Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine

Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Contact Info

Product

Resources

About