Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Protocol for Comparing Benzodiazepine-Ketamine and Benzodiazepine-Fentanyl Sedation in Phacoemulsification (BEKEF): A Double-Blind Crossover Non-Inferiority Clinical Trial Study

BACKGROUND

Cataract surgery, particularly phacoemulsification, often requires sedation alongside topical anesthesia to manage patient anxiety and discomfort. This protocol proposes a study comparing the efficacy of ketamine and fentanyl, both combined with benzodiazepine, as sedation options for patients undergoing bilateral phacoemulsification.

METHODS

In a randomized, double-blind, crossover clinical trial, at least 48 patients scheduled for bilateral cataract surgery will receive fentanyl with midazolam for one eye and ketamine with midazolam for the other. Sedation levels will be assessed using the Ramsay Sedation Scale, and the SURG-TLX Scale will measure intraoperative difficulties. Secondary outcomes include anesthesia-related complications, pain scores, and patient satisfaction.

RESULTS

The primary outcomes, utilizing the Ramsay Sedation Scale, will determine if ketamine combined with a benzodiazepine is non-inferior to fentanyl combined with a benzodiazepine for sedation during phacoemulsification. Secondary outcomes will provide insight into complications, patient and surgeon comfort, and overall satisfaction.

CONCLUSION

This trial will evaluate whether ketamine offers a safe and effective alternative to fentanyl for sedation in cataract surgery, potentially optimizing sedation protocols to enhance patient and surgeon experiences.

Comparing the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery: A double-blind randomized clinical trial

AIM

The aim of this study was to compare the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery (CS) who received tetracaine.

METHODS

This double-blind randomized clinical trial was conducted in 2022. Participants were the candidates for CS consecutively selected from Amirkabir hospital, Arak, Iran, and were assigned to an artificial tear group, a ketorolac group, and a diclofenac group through block randomization. Pain, sedation status, heart rate, blood pressure, and arterial oxygen saturation were assessed during and after surgery. Complications prevalence and intraoperative propofol use were also documented. Data were analyzed using the SPSS software (v. 20.0) at a significance level of <0.05.

RESULTS

There were no significant differences among the study groups respecting participants' age, gender, body mass index, blood pressure, heart rate, arterial oxygen saturation, CS duration, and Aldrete score (P > 0.05). From 5 min after CS onward, the mean score of pain in the ketorolac group was significantly less than the other groups (P < 0.05). The mean score of sedation from recovery to 1 h after surgery in the artificial tear group was significantly more than the other groups, whereas the mean score of sedation 2 and 4 h after CS in the ketorolac group was significantly more than the other groups (P < 0.05). Propofol use in the artificial tear group was significantly more than in other groups (P = 0.001) and patient and surgeon satisfaction in this group was significantly less than in other groups (P < 0.05). The ketorolac and the diclofenac groups did not significantly differ from each other respecting surgeon and patient satisfaction and the prevalence of complications (P > 0.05).

CONCLUSION

Ketorolac eye drops are more effective than diclofenac eye drops in significantly reducing intraoperative pain among the candidates for CS with topical anesthesia. Therefore, ketorolac eye drops can be used with tetracaine eye drops in CS with topical anesthesia to produce greater perioperative analgesia and sedation.

Comparison between remimazolam and propofol anaesthesia for interventional neuroradiology: a randomised controlled trial

BACKGROUND

General anaesthesia can immobile patients during interventional neuroradiology to improve image quality. Remimazolam, an ultrashort-acting benzodiazepine, is advantageous for haemodynamic stability. This study compared remimazolam and propofol anaesthesia during neuroradiology procedures regarding intraoperative hypotensive events and rapid recovery.

METHODS

This single-masked randomised-controlled study included 76 participants who underwent elective endovascular embolisation in a single centre. Patients were randomised between a continuous remimazolam infusion (n = 38) or a target-controlled propofol infusion group (n = 38). In the remimazolam group, flumazenil (0.2 mg) was administered at the end of the procedure. Phenylephrine was titrated to maintain the mean arterial pressure within ± 20% of the baseline value. The primary outcome was the total phenylephrine dose during the procedure.

RESULTS

The total phenylephrine dose was 0.0 [0.0-30.0] μg in the remimazolam group and 30.0 [0.0-205.0] μg in the propofol group (p = 0.001). Hypotensive events were observed in 11 (28.9%) patients in the remimazolam group and 23 (60.5%) patients in the propofol group (p = 0.001). Recovery times to spontaneous breathing, eye-opening, extubation, and orientation were shorter in the remimazolam group than in the propofol group (all p < 0.001).

CONCLUSIONS

Remimazolam anaesthesia showed superior haemodynamic stability compared with propofol anaesthesia during neuroradiology procedures. Systematic use of flumazenil enabled rapid recovery from remimazolam anaesthesia.

REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry; Registration number: UMIN000047384; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000054046.

Comparison of the Sedative Effects of Dexmedetomidine and Remifentanil in Vitrectomy Surgery: A Retrospective Study

Background Vitrectomy surgery is a painful and lengthy procedure. Therefore, administering sedation to reduce patient agitation provides both surgical comfort and hemodynamic stability. However, various complications can arise during the perioperative period depending on the sedation agent used. In our study, we aimed to evaluate the effects of dexmedetomidine and remifentanil sedation applications on patient hemodynamics and perioperative complications in vitrectomy surgery. Methods Our retrospective study included patients aged 18-70 who underwent vitrectomy surgery between 2021 and 2022 with complete file data and ASA scores of 1-3 after obtaining approval from our hospital's ethics committee. Patients were classified into two groups based on the sedation agent used: Group D for dexmedetomidine and Group R for remifentanil. Demographic data of patients, heart rate, mean arterial pressure, oxygen saturation, and bispectral index values during perioperative monitoring, operation duration, and complications such as perioperative nausea, vomiting, and low saturation were recorded. The data of both groups were statistically evaluated, with p<0.05 values considered statistically significant. Results Because of missing data in 18 out of 58 patient files, these cases were excluded from the study. A total of 40 patients were included in the study, with 20 in Group D and 20 in Group R. The mean age of the patients was 64. Among them, 18 (45%) were male, and 22 (55%) were female. The mean operation duration was 61.8 ± 24.1 minutes in Group D and 56.3 ± 17.2 minutes in Group R. The heart rate in Group D was statistically significantly lower than in Group R, starting from the 20th minute of the perioperative period. There were no significant differences between the groups in terms of mean arterial pressure, oxygen saturation, and bispectral index values. One case of bradycardia occurred in Group D, requiring intervention. Conclusion In vitrectomy surgery, both dexmedetomidine and remifentanil infusions can be used for sedation, but caution is advised regarding bradycardia in Group D. Anticipating potential complications with an experienced anesthesia team is crucial for both patient and surgical comfort.

Comparison of the Sedative, Hemodynamic, and Anesthetic Effect of Dexmedetomidine, Ketamine, and Etomidate on Cataract Surgery by Phacoemulsification Method: A Randomized Clinical Trial

Purpose

To compare dexmedetomidine, ketamine, and etomidate in the induction of sedation and hemodynamic changes in patients undergoing cataract surgery by phacoemulsification method.

Methods

This was a double-blind clinical trial study carried out on 128 patients. Using the block randomization method, the patients were divided into four equal groups (dexmedetomidine, ketamine, etomidate, and control). Mean arterial pressure, heart rate, and arterial oxygen saturation, Ramsay Sedation Score were recorded every 5 min intraoperatively, in recovery, and 1, 2, 4, and 6 h postoperatively. Moreover, the Aldrete score was measured in recovery time for discharge from the recovery room.

Results

The mean age of participants was found to be 63.16 ± 6.07 years, and there was no statistically significant difference between the groups in terms of age, sex, and body mass index, SpO_2, and heart rate (P > 0.05). From 15 min after the start of surgery to 6 h postoperatively, the mean arterial pressure in the dexmedetomidine group was significantly lower than that in the other three groups, including ketamine, etomidate, and control (P < 0.05). The mean sedation score (Ramsay) during recovery and 1 h postoperatively was higher in the dexmedetomidine group compared with that in the control group, whereas the recovery time in the dexmedetomidine group was higher than that in the other groups (P < 0.001). In addition, the amount of propofol consumption in the two groups of dexmedetomidine and ketamine was significantly less than that in the etomidate and control groups (P < 0.001).

Conclusions

According to the results, dexmedetomidine caused better hemodynamic changes with more reduction in blood pressure and heart rate, and patients in the dexmedetomidine group did not require any specific medical treatment. Moreover, higher patient satisfaction and longer recovery duration were observed in the dexmedetomidine group than in the other study groups. As such, it is suggested that dexmedetomidine be used as an adjuvant in cataract surgery for more sedation, analgesia, and optimal intraoperative conditions.

Single bolus dexmedetomidine versus propofol for treatment of pediatric emergence delirium following general anesthesia

BACKGROUND

Pediatric emergence delirium is a psychomotor disorder occurring in the early postanesthetic stage. There is no clear consensus regarding its treatment; however, dexmedetomidine and propofol have both been shown to be effective.

AIM

In this single-center, randomized, double-blind prospective study, we compared the efficacy of dexmedetomidine against that of propofol in the treatment of established emergence delirium in pediatric patients undergoing general anesthesia.

METHODS

Patients aged 1-14 years, with ASA I or II and severe emergence delirium (Pediatric Anesthesia Emergence Delirium score of ≥15) during the postoperative period following general anesthesia, were randomized to receive intravenous bolus injection of 0.5 μg.kg^-1 dexmedetomidine or 1 mg.kg^-1 propofol. The primary outcome was the pediatric anesthesia emergence delirium (PAED) score after treatment, and the secondary outcome was the recovery time in the postanesthetic care unit.

RESULTS

Of the 53 patients who participated in the study, 26 (49%) were treated with dexmedetomidine and 27 (51%) with propofol. In the dexmedetomidine group, a single-dose intervention was effective for all patients (100%); whereas in the propofol group, 19 patients (70.4%) had PAED score of <12 after the first dose (p = .004; relative risk [95% confidence interval] = 0.1422 [0.113-1.815]). No significant difference in recovery time (median [IQR (range)]) was observed between the dexmedetomidine (20[14-30(10-45)]) and propofol groups (25 [20-40 (10-50)]; p = .056; 95% confidence interval = 0.113-1.815).

CONCLUSIONS

A single bolus of 0.5 μg.kg^-1 of dexmedetomidine was more effective than a single bolus of 1 mg.kg^-1 of propofol in treating emergence delirium during the early postanesthetic stage.

Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.

[Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial]

BACKGROUND AND OBJECTIVES

Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.

METHODS

We enrolled 120 patients (2-7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg^-1 in addition to either propofol (1 mg.kg^-1) or dexmedetomidine (0.5 μg.kg^-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.

RESULTS

There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes respectively, p <0.001). The P-K group showed more oxygen desaturation. Eleven and six patients experienced SpO₂ <92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p=0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.

CONCLUSIONS

The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses.

REGISTRATION NUMBER

Clinical trials.gov (NCT02863861).

Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy

BACKGROUND

Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy.

METHODS

The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses.

RESULTS

In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation.

CONCLUSION

Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.

Effects of Propofol, Dexmedetomidine, or Ketofol on Respiratory and Hemodynamic Profiles in Cardiac Patients Undergoing Transesophageal Echocardiography: A Prospective Randomized Study

OBJECTIVES

The authors aimed to evaluate sedation characteristics, as well as cardiorespiratory effects, of propofol, dexmedetomidine, and ketofol used for conscious sedation during transesophageal echocardiography (TEE).

DESIGN

Prospective double-blind randomized study.

SETTINGS

Tanta University hospitals.

PARTICIPANTS

Seventy-five participants with left-to-right shunt requiring diagnostic TEE interventions. Patients were randomized into three groups-P, Dex, and K-to receive propofol, dexmedetomidine, or ketofol, respectively.

MEASUREMENTS AND MAIN RESULTS

Time to reach targeted sedation level, duration of the procedure, recovery time, hemodynamic parameters, incidence of oxygen desaturation <90%, as well as the cardiologist's satisfaction were recorded. The time onset and offset of sedation, duration of TEE procedure, and the need for rescue propofol were significantly less in the P and K groups compared with group Dex (p value 0.000*, 0.003*, 0.000*, and 0.000* and effect size 0.39, 0.15, 0.21, and 0.34, respectively). Mean arterial pressure, heart rate, and cardiac output significantly decreased in groups P and Dex compared with either baseline or group K. Hypoxic events were more manifest in group P; whereas group K had better cardiologist's satisfaction than the other two groups.

CONCLUSIONS

In the TEE settings, the three agents were capable of attaining the targeted sedation levels , with propofol and ketofol having a faster onset and recovery times compared with dexmedetomidine. Even though dexmedetomidine and ketofol provided a more stable respiratory profile than propofol, ketofol was favorable in providing fewer hemodynamic alterations with better satisfaction scores than both propofol and dexmedetomidine.

Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial

Background and objectives

Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.

Methods

We enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg^-1 in addition to either propofol (1 mg.kg^-1) or dexmedetomidine (0.5 μg.kg^-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.

Results

There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes, respectively, p < 0.001). The P-K group showed more oxygen desaturation. Eleven and 6 patients experienced SpO₂ < 92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p =  0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.

Conclusions

The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses.

Registration number

Clinical trials.gov (NCT02863861).

Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

Background

Cataract surgery is one of the most common procedures performed worldwide in the elderly. Various medications can provide effective anesthesia and analgesia for cataract surgery, but undesirable side effects limit the utility of each medication or combination of medications. Dexmedetomidine may serve as an anesthesia adjunct for outpatient cataract surgery in the elderly.

Methods

Searches were conducted in Cochrane, Embase, and PubMed for randomized clinical trials investigating the use of dexmedetomidine in adult patients undergoing outpatient, or ambulatory, cataract surgery with sedation and topical or peribulbar block. Ninety-nine publications were identified, of which 15 trials satisfied the inclusion criteria. A total of 914 patients were included in this review. The following data were collected: American Society of Anesthesiologists’ (ASA) physical status and age of study patients; method of blinding and randomization; medication doses and routes of administration; and intraoperative levels of sedation. We also recorded statistically significant differences between dexmedetomidine and other study medications or placebo with respect to the following outcomes: hemodynamic and respiratory parameters; pain; sedation; post-operative nausea and vomiting (PONV); discharge from post-anesthesia care unit (PACU) or recovery times; patient satisfaction; surgeon satisfaction; and effects on intraocular pressure (IOP).

Results

Hypotension with or without bradycardia was reported following bolus doses of dexmedetomidine ranging from 0.5–1.0 mcg/kg with or without a continuous dexmedetomidine infusion. Delayed PACU discharge times were associated with the use of dexmedetomidine, but no clear association was identified between delayed recovery and higher levels of intraoperative sedation. Better analgesia and higher patient satisfaction were commonly reported with dexmedetomidine as well as reductions in IOP.

Conclusions

Overall, this review demonstrates better analgesia, higher patient satisfaction, and reduced IOP with dexmedetomidine for outpatient cataract surgery when compared to traditional sedatives, hypnotics, and opioids. These benefits of dexmedetomidine, however, must be weighed against relative cardiovascular depression and delayed PACU discharge or recovery times. Therefore, the utility of dexmedetomidine for outpatient cataract surgery should be considered on a patient-by-patient basis.

A prospective randomized double-blinded study of dexmedetomidine versus propofol infusion for orbital surgeries

PURPOSE

Orbital surgeries are traditionally taken up under general anesthesia. Local anesthesia combined with moderate sedation can also be considered as an alternative option. This study was performed to compare the safety and efficacy of dexmedetomidine and propofol infusion for orbital surgeries under local anesthesia.

METHODS

Twenty patients undergoing orbital surgery by a single surgeon were enrolled in this prospective randomized study. Selected patients were randomly administered dexmedetomidine (Group D) or propofol (Group P). Hemodynamic and respiratory effects, sedation levels, recovery profile, analgesic properties, and satisfaction levels of the patients and the surgeon were assessed.

RESULTS

There was a significant decrease in mean arterial pressures following drug administration compared to initial measurements in both the groups. However, a statistically significant decrease in heart rate was observed only in Group P. The sedation score at the end of loading dose was 3.3 ± 0.82 in Group D and 2.5 ± 0.52 in Group P and this difference was also statistically significant (P value-0.027). The surgeon's satisfaction score was 6.5 ± 0.71 in Group D and 5.6 ± 1.07 in Group P (P value - 0.045). There were no statistically significant differences observed in patients' satisfaction, pain, and anxiety scores in either group. No major hemodynamic changes or complications were noted in either of the groups.

CONCLUSION

Dexmedetomidine, in comparison to propofol, provides better sedation levels with good hemodynamic stability. It also offers better surgeon satisfaction, thus providing a useful alternative for general anesthesia in selective patients undergoing orbital surgery.

Comparison of Intravenous Dexmedetomidine-Propofol Versus Ketofol for Sedation During Awake Fiberoptic Intubation: A Prospective, Randomized Study

Background

Management of difficult airway due to laryngeal mass is a major challenge to the anesthesiologists, and awake fiberoptic intubation (AFOI) would be the technique of choice.

Objectives

The current study aimed at comparing the effects of administration of dexmedetomidine-propofol or ketofol for sedation during AFOI in terms of intubation conditions, hemodynamic stability, and patients and anesthesiologist’s satisfaction.

Methods

Eighty adult patients, 18 - 60 years old, ASA (the American Society of Anesthesiologists) physical status I-III, with difficult airway due to laryngeal mass and planned for AFOI were enrolled. Sedation was randomly given to the patients according to their assigned group by either dexmedetomidine-propofol (group D; n = 40) or ketofol (group K; n = 40). Outcome variables included time to reach Ramsay sedation scale (RSS) ≥ 3, intubation time, number of patients in need of rescue propofol, patient’s discomfort score, tolerance to endoscopy and intubation, hemodynamic parameters, patients and anesthesiologist’s satisfaction, and occurrence of side effects.

Results

Time to reach RSS ≥ 3 and intubation time were significantly shorter, and fewer patients required rescue propofol in the K group as compared to the D group (P = 0.000*, and 0.035*, respectively). Higher discomfort score and better tolerance to endoscopy and intubation were noticed in group K than group D, but with no statistical significance (P = 0.132, 0.137, and 0.211, respectively). Patients in group D had significantly lower mean arterial pressure (MAP) and heart rate (HR) after the loading dose till five minutes after intubation (P = 0.000*). There was no significant difference in patients’ satisfaction between the two groups (P = 0.687), while anesthesiologist’s satisfaction was higher in group K compared with that of group D (P = 0.013*). Cough score as well as incidence of unfavorable respiratory outcomes were not significantly different between the two groups (P = 0.611, 0.348, respectively).

Conclusions

Ketofol and dexmedetomidine-propofol combination were suitable and satisfactory for AFOI. However, ketofol was more advantageous in offering faster onset of sedation, shorter intubation time, stable hemodynamic profile, as well as higher anesthesiologist’s satisfaction when compared to dexmedetomidine-propofol.

Dexmedetomidine versus ketofol sedation for outpatient diagnostic transesophageal echocardiography: A randomized controlled study

Background

Moderate sedation is required for out-patient transesophageal echocardiography (TEE). Our objective was to compare the effect of Ketofol and dexmedetomidine for outpatient procedural sedation in diagnostic TEE with a hypothesis that Ketofol would be as effective as dexmedetomidine. Patients and.

Methods

Fifty adult patients of age group 18-60 years with atrial septal defect, rheumatic valvular heart disease undergoing diagnostic TEE in the outpatient echocardiography laboratory were randomized into two groups, group D and group KF. GROUP D: Dexmedetomidine infusion -200 μg in 20 ml normal saline. GROUP KF: Ketofol infusion: (ketamine: propofol, 1mg: 3 mg in 20 ml syringe). Loading dose of drug at 1ml/kg/hour IV till Ramsay sedation score (RSS) ≥ 3 achieved followed by maintenance infusion at 0.05 ml/kg/hour till end of procedure.

Results

The primary outcome - time to achieve Ramsay sedation score ≥ 3 was significantly lesser with Ketofol as compared to Dexmedetomidine 260[69] seconds vs 460 [137], (p value<0.05).

Conclusion

In out-patient setting, ketofol is favourable over dexmedetomidine for sedation regimen for diagnostic TEE as lesser time is taken to achieve optimal sedation with lesser hemodynamic perturbations, post procedure complications and better cardiologist satisfaction.