The effect of ketamine on hypoventilation during deep sedation with midazolam and propofol: a randomised, double-blind, placebo-controlled trial.
Eur J Anaesthesiol 2015;
31:654-62. [PMID:
24247410 DOI:
10.1097/eja.0000000000000025]
[Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND
Hypoventilation is a major cause of morbidity and mortality in patients having procedures under sedation. Few clinical strategies have been evaluated to reduce intraoperative hypoventilation during surgical procedures under deep sedation.
OBJECTIVE
The primary objective of this investigation was to examine the effect of ketamine on hypoventilation in patients receiving deep sedation for surgery with midazolam and propofol.
DESIGN
The study was a randomised, placebo-controlled, double-blind clinical trial.
SETTING
Intraoperative.
PATIENTS
Healthy women undergoing breast surgery.
INTERVENTION
Randomised to receive ketamine (0.5 mg kg bolus, followed by an infusion of 1.5 μg kg min) or isotonic saline.
MAIN OUTCOME MEASURE
Duration of hypercapnia measured continuously with a transcutaneous carbon dioxide (TCO2) monitor.
RESULTS
Fifty-four participants were recruited. Patient and surgical characteristics were similar between the study groups. The median percentage of the sedation time with TCO2 more than 6.7 kPa in participants in the ketamine group, 1.2% (95% confidence interval, CI, 0 to 83), was less than that in the isotonic saline group (65%, 95% CI, 0 to 88; P = 0.01). Severe hypoventilation (TCO2 >8.0 kPa) was also less in the ketamine group, median 0% (95% CI, 0 to 11.7) compared with 28% (95% CI, 0 to 79.3; P = 0.0002) for the isotonic saline group. The ketamine group required less airway manoeuvres (chin lift) to keep the SaO2 greater than 95% median (95% CI) [0 (0 to 3) compared with 3 (0 to 16) in the isotonic saline group] (P = 0.004).
CONCLUSION
Ketamine decreased the duration and severity of hypercapnia in patients undergoing deep sedation with propofol. The addition of ketamine may reduce hypoventilation and adverse effects in patients having procedures under sedation.
TRIAL REGISTRATION
clinicaltrials.gov identifier: NCT01535976.
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