Evaluation of Different Sedatives for Colonoscopy

Author(s): Waseem M. Seleem, Khadeja M. El Hossieny, Sherief Abd-Elsalam*

Journal Name: Current Drug Safety

Volume 15 , Issue 1 , 2020

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Graphical Abstract:


Background and Aims: Sedation and analgesia are important elements of endoscopic examinations; sedation for colonoscopy aims to relieve patient discomfort and anxiety, improve the outcome of the examination, diminish the patient’s memory of the event and achieve comfortable and technically successful endoscopic procedure.

Methods: Our prospective study was carried out on 150 patients who were referred for colonoscopy; they were divided into two groups based on the pre-endoscopic sedation given for them: propofol fentanyl or propofol ketamine. Detailed histories, thorough physical examinations, and routine laboratory investigations were performed for all patients, along with monitoring of their vital signs and oxygen saturation levels (before, during and after colonoscopy), to assess safety, efficacy, recovery times, complications of the sedative drugs, comfort of the patients and endoscopists.

Results: There was no statistically significant difference between the two groups in terms of age, sex and Body Mass Indexes (BMI). With respect to their Mean Arterial Blood Pressures (MAPs) and heart rates, there was high hemodynamic stability in the propofol ketamine group, and both the groups were efficacious, although the propofol fentanyl group had shorter recovery times than the propofol ketamine group (3±1.7 minutes and 4±2.8 minutes, respectively). However, nausea, vomiting and hypoxia were common in the propofol fentanyl group, while hallucinations were common in the propofol ketamine group. In propofol fentanyl group; there was a significant decrease in the heart rate more common in females (with age range 39-58 years) during and after colonoscopy [p value 0.01].

Conclusion: Sedation with propofol ketamine during colonoscopy was found to be safe and efficacious to achieve hemodynamic stability with fewer complications than propofol fentanyl.

Keywords: Sedation, colonoscopy, ketamine, propofol, fentanyl, recovery time.

Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336(7650): 924-6.
[http://dx.doi.org/10.1136/bmj.39489.470347.AD] [PMID: 18436948]
Gross JB, Farmington CT, Bailey PL, et al. Practice guidelines for sedation and analgesia by non anaesthsiologist. Anaesthsiology 4 2002; 96: 1004-17.
Faigel DO, Baron TH, Goldstein JL, et al. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc 2002; 56(5): 613-7.
[http://dx.doi.org/10.1016/S0016-5107(02)70104-1] [PMID: 12397263]
Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. Gastrointest Endosc 2009; 70(6): 1053-9.
[http://dx.doi.org/10.1016/j.gie.2009.07.020] [PMID: 19962497]
Vargo JJ, DeLegge MH, Feld AD, et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc 2012; 76(1): e1-e25.
[http://dx.doi.org/10.1016/j.gie.2012.03.001] [PMID: 22624793]
Abdalla MW, El Shal SM, El Sombaty AI, et al. Propofol dexmedetomidine versus propofol ketamine for anesthesia of endoscopic retrograde cholangiopancreatography (ERCP) (A randomized comparative study). Egyptian J Anaethesia 2015; 31(2): 97-105.
Yang JF, Farooq P, Zwilling K, Patel D, Siddiqui AA. Efficacy and safety of propofol-mediated sedation for outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP). Dig Dis Sci 2016; 61(6): 1686-91.
[http://dx.doi.org/10.1007/s10620-016-4043-3] [PMID: 26825844]
Smith A, Silvestro L, Rodriguez RE, Austin PN. Evidence-based selection of sedation agents for patients undergoing endoscopic retrograde cholangiopancreatography. Gastroenterol Nurs 2016; 39(1): 32-41.
[http://dx.doi.org/10.1097/SGA.0000000000000195] [PMID: 26825562]
Correia LM, Bonilha DQ, Gomes GF, et al. Sedation during upper GI endoscopy in cirrhotic outpatients: A randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl. Gastrointest Endosc 2011; 73(1): 45-51.
[http://dx.doi.org/10.1016/j.gie.2010.09.025] [PMID: 21184869]
Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: A randomized double-blind trial. Ann Emerg Med 2012; 59(6): 504-12.
[http://dx.doi.org/10.1016/j.annemergmed.2012.01.017] [PMID: 22401952]
Hamada Y, Kameyama Y, Iizuka T, et al. Effects of propofol and fentanyl anesthesia on heart rate variability using two analytical methods. Eur J Anaesthesiol 2004; 21: A-98-25.
Vettorello M, Colombo R, De Grandis CE, Costantini E, Raimondi F. Effect of fentanyl on heart rate variability during spontaneous and paced breathing in healthy volunteers. Acta Anaesthesiol Scand 2008; 52(8): 1064-70.
[http://dx.doi.org/10.1111/j.1399-6576.2008.01713.x] [PMID: 18840105]
Aydogan H, Aydogan T, Uyankoglu A, et al. Propofol-ketamine combination has shorter recovery timeswith similar hemodynamics compared to propofol alone in upper gastrointestinal endoscopy in adults: A randomized trial. Acta Med Okayama 2012; 29: 259-64.
Andolfatto G, Willman E. A prospective case series of single-syringe ketamine-propofol (Ketofol) for emergency department procedural sedation and analgesia in adults. Acad Emerg Med 2011; 18(3): 237-45.
[http://dx.doi.org/10.1111/j.1553-2712.2011.01010.x] [PMID: 21401785]
Moerman AT, Struys MM, Vereecke HE, Herregods LL, De Vos MM, Mortier EP. Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration. J Clin Anesth 2004; 16(4): 237-43.
[http://dx.doi.org/10.1016/j.jclinane.2003.08.005] [PMID: 15261312]
Poulos J, Kalogerinis P, Caudle J. Propofol plus fentanyl compared with combination of midazolam plus fentanyl for endoscopy in a community setting. AANA J 2013; 81: 31-6.
[PMID: 23513321]
Holden JE, Jeong Y, Forrest JM. The endogenous opioid system and clinical pain management. AACN Clin Issues 2005; 16(3): 291-301.
[http://dx.doi.org/10.1097/00044067-200507000-00003] [PMID: 16082232]
Powers AR, Gancsos MG, Finn ES, et al. Ketamine-induced hallucinations. Psychopathology 2015; 48: 376-85.
Shah A, Msdossy G, MacLeod N, et al. Randomized controlled trial to evaluate ppropofol ketamine versus ketamine alone for procedural sedation in children. Ann Emerg Med 2011; 57(5): 425-33.

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Article Details

Year: 2020
Published on: 26 July, 2019
Page: [20 - 24]
Pages: 5
DOI: 10.2174/1574886314666190726154238

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