Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial

Abstract

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.ObjectivesIn this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.MethodsIn this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.ResultsThe sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).ConclusionsThe results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.

Analgesic Effect and Hemodynamic Changes Due to Dexmedetomidine Versus Fentanyl During Elective Colonoscopy: A Double-Blind Randomized Clinical Trial

“…Midazolam is prescribed for endoscopic sedation. Midazolam has a sedative, anti-anxiety, amnesic effect, but it is not an analgesic (1, 5). Narcotic drugs such as meperidine and fentanyl are commonly used for endoscopy.…”

“…They should be used with benzodiazepine carefully and at low doses for elderly patients, those with severe liver and kidney diseases, and those who have a history of seizure. Since the onset and clearance of fentanyl are rapid, it is preferred over meperidine (1, 5).…”

“…Its most important complication is respiratory depression, which is exacerbated by the simultaneous administration of sedation, and its most serious complication is cardiovascular complications (low blood pressure and heart rate). Risk factors for these complications include old age, underlying diseases, especially pulmonary diseases, dementia, and anemia (1, 5).…”

“…The onset of hypnosis after a dose of 2.5 mg/kg is fast. The most prominent cardiovascular complication of propofol is the reduction of blood pressure (1, 5, 10). If fentanyl and propofol are used simultaneously, side effects are exacerbated; so, the risk of apnea and hemodynamic changes will be higher and can challenge the anesthetist (1, 5).…”

Ketamine with Propofol for Endoscopic Procedures

“…The incidence of respiratory depression and post procedural drowsiness was lower with a 4 : 1 ratio (160 mg propofol and 40 mg ketamine) than with other ratios of ketofol. In another study, Gorji et al [ 3 ] evaluated combinations of propofol with ketamine and fentanyl for endoscopic retrograde cholangiopancreatography. One group received ketamine 0.5 mg/kg, while the other group was administered fentanyl 50–100 μg.…”