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Fukano K, Iizuka Y, Ueda T, Fukuda Y, Otsuka Y, Sanui M. Comparison of Sedation With Ketamine-Propofol Versus Propofol-Fentanyl for Elderly Patients Undergoing Prostate Biopsy: A Retrospective Observational Study. Cureus 2023; 15:e42650. [PMID: 37644922 PMCID: PMC10461593 DOI: 10.7759/cureus.42650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Procedural sedation is increasingly used for elderly patients, but there is no established ideal method for elderly patients who are prone to respiratory and circulatory depression. This study aims to investigate the association of respiratory complications and the combination of ketamine-propofol versus fentanyl-propofol in elderly patients undergoing prostate biopsy requiring deep sedation. METHODS This was a single-center, retrospective, observational study conducted from April 2020 to March 2021. We included male patients aged 65 years and older scheduled for prostate biopsy under procedural sedation. Ketamine-propofol and fentanyl-propofol were administered at the discretion of the anesthesiologist. The primary outcome was the need for assisted ventilation. The secondary outcome was the duration of oxygen saturation (SpO2) below 90%. RESULTS We enrolled 120 patients over 65 years, and 92 patients were included in the final analysis. The anesthesiologist administered an initial dose of ketamine and propofol of 1:1 to 1:4 of 1.0 mg kg-1 (interquartile range: 0.98 to 1.17) or administered an initial dose of fentanyl of 0.05 to 0.1 mg and a target-controlled infusion of propofol of 2.8 μg ml-1 (interquartile range: 2.0 to 3.0) followed by additional doses at the discretion of the anesthesiologist. Ketamine-propofol was associated with a reduced need for assisted ventilation and a shorter duration of SpO2 below 90% than propofol-fentanyl (95.7% vs. 4.3%, P < 0.05; 0.64 minutes vs. 0.17 minutes, P = 0.26). CONCLUSIONS Ketamine-propofol is associated with a significantly reduced need for assisted ventilation compared to propofol-fentanyl during procedural sedation and analgesia for procedures requiring deep sedation for the elderly.
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Affiliation(s)
- Kentaro Fukano
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yusuke Iizuka
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Takahiro Ueda
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yu Fukuda
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yuji Otsuka
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
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Choi EJ, Kim CH, Yoon JY, Kim EJ. Ketamine-propofol (ketofol) in procedural sedation: a narrative review. J Dent Anesth Pain Med 2023; 23:123-133. [PMID: 37313271 PMCID: PMC10260354 DOI: 10.17245/jdapm.2023.23.3.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
Sedation methods for dental treatment are increasingly explored. Recently, ketofol, which is a combination of ketamine and propofol, has been increasingly used because the advantages and disadvantages of propofol and ketamine complement each other and increase their effectiveness. In this review, we discuss the pharmacology of ketamine and propofol, use of ketofol in various clinical situations, and differences in efficacy between ketofol and other sedatives.
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Affiliation(s)
- Eun-Ji Choi
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, Republic of Korea
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, Republic of Korea
| | - Ji-Young Yoon
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, Republic of Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, Republic of Korea
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Zheng L, Wang Y, Ma Q, Liang W, Zhang X, Ren Z, Qin W, Meng F, Li Y, Fan G, Yin N. Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:1347-1356. [PMID: 37168489 PMCID: PMC10166102 DOI: 10.2147/dddt.s408076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy. Patients and Methods A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded. Results Propofol consumption was 274.4±22.6 mg and 201.3±16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4±2.3 s and 17.8±1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2±1.1 min and 4.8±1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58±0.49 vs 3.71±0.83) and (4.75±0.44 vs 3.33±0.92), respectively. Conclusion The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application. Clinical Trials Registration ChiCTR 2200062547.
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Affiliation(s)
- Longbin Zheng
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yiteng Wang
- Department of Anesthesiology, Xinchang County People’s Hospital, Xinchang, Zhejiang Province, People’s Republic of China
| | - Qing Ma
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Wenbo Liang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xiaojing Zhang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Zhiqiang Ren
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Weimin Qin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Fan Meng
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yuhong Li
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Guoxiang Fan
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Ning Yin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
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Can Bispectral Index Monitoring (EEG) be an Early Predictor of Respiratory Depression under Deep Sedation during Endoscopic Retrograde Cholangiopancreatography? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:444-450. [PMID: 33364885 PMCID: PMC7751237 DOI: 10.14744/semb.2020.10476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/14/2020] [Indexed: 11/20/2022]
Abstract
Objectives: The more often the endoscopy sedation is performed, the more the risk of adverse events, and therefore, advanced monitoring becomes more and more essential in endoscopy units. The present study aims to evaluate whether the Bispectral Index (BIS) monitoring is an early predictor of respiratory depression and to determine the compliance between commonly used clinical sedation score. Methods: This study was approved by the ethics committee. The sample consisted of 60 patients aged 18 to 50 years with an American Society of Anesthesiologists (ASA) physical status of I scheduled for endoscopic retrograde cholangiopancreatography (ERCP). All patients received propofol mediated sedation. Ramsay sedation score (RSS) was used as a clinical sedation score to assess the depth of sedation. Participants were attached to a BIS monitor. Perioperative hemodynamics, BIS values, the mean dose of propofol, procedure duration, apnea, frequency of oxygen desaturation and airway-related interventions, as well as demographic parameters, were recorded. BIS scores were blinded to RSS data. Results: The study sample consisted of 60 patients (36 females) aged 18 to 50 years (mean: 36.10±8.02). The mean procedure time and the dose of propofol were 32.70±1.79 min and 287.17±59.66 mg, respectively. The cut-off values for respiratory depression were as follows. At the 15th min of measurement, the BIS score of 60 had 96.2% sensitivity and 42.9% specificity. At the 20th min of measurement, the BIS score of 59.50 had 98.2% sensitivity and 100.0% specificity. At the 25th min of measurement, the BIS score of 59.00 had 98.3% sensitivity and 50.0% specificity. Regression analysis showed that the mean BIS score (p=0.000, 95%CI-0.110-0.043) increased by 0.076 with a unit increase in the RSS. Conclusion: BIS was highly correlated with RSS, and therefore, can be used to avoid respiratory depression during sedation.
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Ali I, Alahdal M, Xia H, S El Moughrabi A, Shiqian H, Yao S. Ketofol performance to reduce postoperative emergence agitation in children undergoing adenotonsillectomy. Libyan J Med 2020; 15:1688450. [PMID: 31771436 PMCID: PMC6882471 DOI: 10.1080/19932820.2019.1688450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Emergence agitation is a reformed state of mindfulness, which starts with a sudden form of anesthesia and progresses through the early repossession age. Thus, the purpose of this study is to evaluate 1:3 ketofol performance on children 3–15 years old undergoing adenotonsillectomy.Methods: A total of 60 children aged 3–15 years undergoing adenotonsillectomy were randomly allocated to receive low-dose ketamine 0.15 mg/kg followed by propofol 0.45 mg/kg i.v. ketofol (1:3) about 10 min before the end of surgery in comparison to 60 children aged 3–15 years who received only normal saline and dextrose. Anesthesia was induced and maintained with sevoflurane. Postoperative pain and EA were assessed with objective pain score (OPS) and the Pediatric Anesthesia Emergence Delirium (PAED) scale, respectively. EA was defined as a PAED 10 points. Recovery profile and postoperative complications were also recorded.Results: The incidence and severity of EA were found significantly lower in the ketofol group in comparison to the control group with a percentage of (13.33% vs 48.33%) (8% vs 15%) respectively (P < 0.05). Also, the time for interaction from anesthetic tainted to extubating in the ketofol set was significantly less than in the control group (P < 0.05). Interestingly, there are no opposing events such as nausea, laryngospasm, bronchospasm, hypotension, bradycardia, bleeding, or postoperative respiratory depression (respiratory rate: <16) were noticed in the ketofol supervision (P > 0.05). Moreover, the heart rate was meaningfully higher in the control group starting at the time of tracheal extubating in comparison to the children undergone ketofol (P < 0.05). Alert score and time from painkilling tainted till liberation from PACU showed substantial significant changes at ketofol set (P < 0.05).Conclusion: Ketofol (1:3) shows significant performance to reduce postoperative agitation in the children undergone adenotonsillectomy.
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Affiliation(s)
- Idress Ali
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesiology, Alwehda Teaching Hospital, Dhamar University, Dhamar city, Yemen
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen, P. R. China.,Department of Medical Laboratories, school of medicine, Hodeidah University, Al-Hudaydah city, Yemen
| | - Haifa Xia
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Arafa S El Moughrabi
- Department of Oral & Maxillofacial Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huang Shiqian
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanglong Yao
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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