Varadarajulu Shyam, Tamhane Ashutosh, Wilcox C Mel
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
J Gastroenterol Hepatol. 2008 Aug;23(8 Pt 2):e405-9. doi: 10.1111/j.1440-1746.2007.05024.x. Epub 2007 Jun 25.
Performance of sphincter of Oddi manometry (SOM) at endoscopic retrograde cholangio-pancreatogram (ERCP) is technically demanding and requires that the patient be well sedated. Droperidol is used as an adjunctive agent in patients who are difficult to sedate. Concerns regarding the safety profile of droperidol and its effects on sphincter of Oddi motility has resulted in the search for other potent sedative agents that do not influence SOM readings. Ketamine, a dissociative anesthetic, is increasingly being used as an adjunctive agent for conscious sedation. This study evaluates the effect of ketamine on sphincter of Oddi motility when used as an adjunctive sedative agent during ERCP.
This is a prospective study of 30 consecutive patients undergoing SOM who were difficult to sedate and required adjunctive ketamine. Manometry was initially performed with intravenous administration of diazepam plus meperidine or a combination of diazepam plus meperidine and midazolam. After the initial two pull-throughs, 20 mg of ketamine was administered intravenously and the measurements were repeated 5 min later.
The basal pressures of the biliary sphincter and of the pancreatic sphincter were not significantly altered by ketamine. By using a definition for sphincter of Oddi dysfunction of a basal pressure >or=40 mmHg, concordance (normal vs abnormal) between the basal sphincter pressure before and after ketamine was seen in 28 patients (93%). Ketamine also did not lead to a difference in phasic wave amplitude, duration, or frequency. No complication was associated with ketamine use.
Ketamine at 20 mg did not significantly affect SOM parameters. Further studies are required to confirm our preliminary findings before ketamine can be added to the armamentarium of agents used for performance of sphincter of Oddi manometry.
在内镜逆行胰胆管造影术（ERCP）中进行Oddi括约肌测压（SOM）技术要求较高，且需要患者充分镇静。氟哌利多被用作难以镇静患者的辅助药物。由于对氟哌利多安全性及其对Oddi括约肌运动的影响存在担忧，人们开始寻找其他不影响SOM读数的有效镇静剂。氯胺酮是一种解离性麻醉剂，越来越多地被用作清醒镇静的辅助药物。本研究评估氯胺酮在ERCP期间用作辅助镇静剂时对Oddi括约肌运动的影响。
这是一项对30例连续接受SOM且难以镇静并需要辅助氯胺酮的患者进行的前瞻性研究。最初测压时静脉注射地西泮加哌替啶或地西泮加哌替啶与咪达唑仑的组合。最初两次拉拽后，静脉注射20mg氯胺酮，5分钟后重复测量。
氯胺酮对胆管括约肌和胰管括约肌的基础压力无显著影响。采用基础压力≥40mmHg作为Oddi括约肌功能障碍的定义，28例患者（93%）在氯胺酮前后基础括约肌压力的一致性（正常与异常）情况良好。氯胺酮也未导致相波幅度、持续时间或频率出现差异。使用氯胺酮未出现并发症。
20mg氯胺酮对SOM参数无显著影响。在氯胺酮可被添加到用于Oddi括约肌测压的药物清单之前，还需要进一步研究来证实我们的初步发现。
