Effects of ketamine or fentanyl addition to propofol on the quality of sedo-analgesia during endoscopic ultrasonography

Year 2019, Volume: 9 Issue: 2, 167 - 170, 30.06.2019

Hayrettin Daşkaya Harun Uysal Ferda Yılmaz İnal Asım Esen Kazım Karaaslan

https://doi.org/10.16899/jcm.578643

Abstract

Aim: Endoscopic ultrasonography procedures are usually
performed in prone position with sedation. In this prospective study we
investigated efficacy, patient and endoscopist satisfaction of sedation with
propofol + ketamin or propofol + fentanyl combinations on patients who
underwent diagnostic EUS.

Materials
and methods: 111 patients were included in the study who were
planned for EUS with sedation. All patients received 1 mg/kg Lidocaine and 0.01
mg / kg Atropine. Propofol + ketamine group (Group K) sedated with 1,5mg/kg
propofol, 1 mg/kg ketamine and propofol + fentanyl group (Group F) sedated with
1,5mg/kg propofol, 1mcg/kg fentanyl. In absence of sedation an additional dose
of 0,2 mg/kg Propofol was applied in both groups. During intraoperative period
patients were recorded with Richmond agitation score, heart rate,
systolic-diastolic-mean blood pressure, peripheric oxygen saturation 5 minutes
interval. Total time of the procedure and total amount of propofol consumed
during this period were recorded. Postoperative nausea, vomiting Numeric Rank Score,
for pain visual pain score and aldrete score were recorded. Endoscopist and
patient satisfaction scores were requested between 0-4 and recorded.

Results: Each group has similar demographic data and operation
time. Total amount of propofol usage was lower in group F (p<0.001). Group F
has shorter Post-Anesthesia Care Unit stay (p<0.001). While endoscopist
satisfaction were same, patient satisfaction were significantly different
(p:001). Intraoperative heart rate and blood pressure were significantly
increased in Group K while these values were more stable in Group F. Post-Anesthesia
Care Unit entrance blood pressure and heart rates were higher in group K.
Intraoperative SpO₂ were not
significantly different. 

Conclusıon: Considering that the majority of patients undergoing
endoscopic procedures has comorbid conditions and elderly and statistically
significant differences has in group K and group F; we think that combination
of fentanyl and propofol is more advantageous for the sedation in endoscopic
ultrasonography cases for esophagus, stomach and pancreas-biliary system 

Keywords

endoscopic ultrasonography, sedo-analgesia, outpatient anesthesia

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Abstract

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron
pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada
tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve
propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta
memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi
amaçlanmaktadır.

Gereç-yöntem: Sedo-analjezi ile endoskopik ultrasonografi işlemi
planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve
0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5
mg.kg^-1 Propofol, 1 mg.kg^-1 Ketamin, Propofol+fentanil
grubuna (Grup F) da 1,5 mg.kg^-1 Propofol, 1 mcg. kg^-1
Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond
Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı,
periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam
propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı
skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten
ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.

Bulgular: Her iki grupta demografik veriler ve total operasyon
süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha
düşüktü (p<0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa
gözlendi (p<0.001). Endoskopist memnuniyetinde herhangi bir fark
gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da
İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar
gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi
giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.

Sonuç: Endoskopik girişim yapılan hastaların büyük
çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda
anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu
açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil
propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz.

Keywords

endoskopik ultrasonografi, sedo-analjezi, ameliyathane dışı anestezi

References

• 1. Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc 2006;64:52-9
• 2. American Association for Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association Institute; American Society for Gastrointestinal Endoscopy; Society for Gastroenterology Nurses and Associates, Vargo JJ, DeLegge MH, Feld AD, Gerstenberger PD, Kwo PY, Lightdale JR et all.. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc 2012;76:e1-e25
• 3. Paspatis GA, Manolaraki MM, Vardas E, Theodoropoulou A, Chlouverakis G. Deep sedation for endoscopic retrograde holangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication. Endoscopy 2008;40:308-13.
• 4. Khutia SK, Mandal MC, Das S, Basu SR. Intravenous infusion of ketamineepropofol can be an alternative to intravenous infusion of fentanilepropofol for deep sedation and analgesia in pediatric patients undergoing emergency short surgical procedures. Indian J Anaesth 2012;56:145-50.
• 5. Joo JD, In JH, Kim DW, Jung HS, Kang JH, Yeom JH, et al. The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patientcontrolled sedation during breast biopsy surgery. Korean J Anesthesiol 2012;63:431-5.
• 6. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–1017.
• 7. Kerker A, Hardt C, Schlief HE, Dumoulin FL. Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients. BMC Gastroenterol. 2010;10:11.
• 8. Eiji Umegaki, Shinya Abe, Satoshi Tokioka, Nozomi Takeuchi, Toshihisa Takeuchi, Yukiko Yoda et al. Risk management for gastrointes¬tinal endoscopy in elderly patients: questionnaire for patients under¬going gastrointestinal endoscopy. J Clin Biochem Nutr. 2010;46(1):73–80.
• 9. Amornyotin S, Srikureja W, Pausawasdi N, Prakanrattana U, Kachintorn U.Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand. Asian Biomed. 2011;5(4):485–491.
• 10. Gullo A. Sedation and anesthesia outside the operating room: definitions, principles, critical points and recommendations. Minerva Anesthesiol 2005;71:1-9.