Baykal Tutal Z, Gulec H, Derelı N, Babayıgıt M, Kurtay A, Inceoz H, Horasanlı E
Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey.
Ir J Med Sci. 2016 Aug;185(3):699-704. doi: 10.1007/s11845-015-1348-8. Epub 2015 Sep 2.
In this study, we compared duration for reaching desired Ramsay Sedation Score (RSS) and postoperative recovery according to Modified Aldrete Score (MAS) of propofol and propofol-ketamine combination in a group of colonoscopy patients. Rates of cardiovascular, respiratory, laryngospasm, visual and nausea/vomiting complications were also compared as secondary outcomes.
This is a double-blinded prospective randomized controlled trial. 95 patients were included and blocked randomized to either propofol (GroupP, n: 47) or propofol-ketamine (GroupPK, n: 48). GroupP patients received 0.5 mg/kg propofol and GroupPK received 0.5 mg/kg ketamine-propofol. Subjects were monitorized noninvasively preoperatively and every 5 min during procedure. RSS was recorded for every minute before starting procedure and for every 5 min during procedure. Recovery after colonoscopy was evaluated according to MAS. Same observer checked for MAS just after procedure in postoperative 1 min and for every 3 min during follow-up. Postoperative respiratory depression was defined as rate <10/min, hypercapnia/hypercarbia-arterial CO2 tension >50 mmHg or SO2 <90 while hypotension was defined as a decrease of 20 % in mean blood pressure compared to initial values.
GroupPK patients needed shorter duration for achieving RSS ≥ 4 (p: 0.038) but longer duration for achieving MAS ≥ 9 (p: 0.005). GroupP's intraoperative blood pressures and heart rates were significantly lower compared to initial values. We observed that respiratory depression (19.1 vs 0 %, p: 0.001), hypotension (29.8 vs 10.4 %, p: 0.018), and nausea/vomiting (17 vs 4.2 %, p: 0.041) were significantly more common in GroupP.
Propofol-ketamine combination is an advantageous choice in means of achieving sedation in a shorter period of time, a better hemodynamic stability, less nausea and vomiting and respiratory complication rates. Yet it seems that this choice might be related with longer recovery duration.
在本研究中，我们比较了一组结肠镜检查患者中，根据改良Aldrete评分（MAS），丙泊酚和丙泊酚-氯胺酮联合用药达到目标Ramsay镇静评分（RSS）的持续时间及术后恢复情况。还比较了心血管、呼吸、喉痉挛、视觉及恶心/呕吐并发症的发生率作为次要结果。
这是一项双盲前瞻性随机对照试验。纳入95例患者，随机分为丙泊酚组（P组，n = 47）或丙泊酚-氯胺酮组（PK组，n = 48）。P组患者接受0.5mg/kg丙泊酚，PK组患者接受0.5mg/kg氯胺酮-丙泊酚。术前对受试者进行无创监测，术中每5分钟监测一次。在开始操作前每分钟记录RSS，术中每5分钟记录一次。根据MAS评估结肠镜检查后的恢复情况。同一名观察者在术后1分钟及随访期间每3分钟检查一次MAS。术后呼吸抑制定义为呼吸频率<10次/分钟、高碳酸血症/动脉血二氧化碳分压>50mmHg或血氧饱和度<90%，低血压定义为平均血压较初始值下降20%。
PK组患者达到RSS≥4所需时间较短（p = 0.038），但达到MAS≥9所需时间较长（p = 0.005）。P组术中血压和心率较初始值显著降低。我们观察到，P组呼吸抑制（19.1%对0%，p = 0.001）、低血压（29.8%对10.4%，p = 0.018）和恶心/呕吐（17%对4.2%，p = 0.041）明显更常见。
丙泊酚-氯胺酮联合用药在较短时间内实现镇静、更好的血流动力学稳定性、更少的恶心呕吐及呼吸并发症发生率方面是一个有利选择。然而，这种选择似乎与更长的恢复时间有关。
