Singh Shweta A, Prakash Kelika, Sharma Sandeep, Dhakate Gaurav, Bhatia Vikram
Department of Anaesthesiology and Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India.
Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.
Korean J Anesthesiol. 2018 Feb;71(1):43-47. doi: 10.4097/kjae.2018.71.1.43. Epub 2017 Jun 14.
We evaluated whether the addition of a small dose of ketamine or fentanyl would lead to a reduction in the total dose of propofol consumed without compromising the safety and recovery of patients having endoscopic ultrasonography (EUS).
A total of 210 adult patients undergoing elective EUS under sedation were included in the study. Patients were randomized into three groups. Patients were premedicated intravenously with normal saline in group 1, 50 µg fentanyl in group 2, and 0.5 mg/kg ketamine in group 3. All patients received intravenous propofol for sedation. Propofol consumption in mg/kg/h was noted. The incidence of hypotension, bradycardia, desaturation, and coughing was noted. The time to achieve a Post Anesthesia Discharge Score (PADS) of 10 was also noted.
There were 68 patients in group 1, 70 in group 2, and 72 in group 3. The amount of propofol consumed was significantly higher in group 1 (9.25 [7.3-13.2]) than in group 2 (8.8 [6.8-12.2]) and group 3 (7.6 [5.7-9.8]). Patient hemodynamics and oxygenation were well maintained and comparable in all groups. The time to achieve a PADS of 10 was significantly higher in group 3 compared to the other two groups.
The use of 50 µg fentanyl or 0.5 mg/kg ketamine in a single dose during EUS reduces the dose of propofol required for sedation. However, unlike the addition of fentanyl, the addition of ketamine increased the time to recovery. Thus, 50 µg fentanyl is a good additive to propofol infusion for sedation during EUS to reduce the requirement for propofol without affecting the time to recovery.
我们评估了添加小剂量氯胺酮或芬太尼是否会导致丙泊酚总消耗量减少，同时又不影响接受内镜超声检查（EUS）患者的安全性和恢复情况。
本研究共纳入210例接受镇静下择期EUS的成年患者。患者被随机分为三组。第1组患者静脉注射生理盐水进行术前用药，第2组注射50μg芬太尼，第3组注射0.5mg/kg氯胺酮。所有患者均接受静脉注射丙泊酚进行镇静。记录丙泊酚每千克每小时的消耗量。记录低血压、心动过缓、血氧饱和度下降和咳嗽的发生率。还记录达到麻醉后出院评分（PADS）为10的时间。
第1组有68例患者，第2组有70例，第3组有72例。第1组丙泊酚消耗量（9.25[7.3 - 13.2]）显著高于第2组（8.8[6.8 - 12.2]）和第3组（7.6[5.7 - 9.8]）。所有组患者的血流动力学和氧合情况均得到良好维持且相当。与其他两组相比，第3组达到PADS为10的时间显著更长。
在EUS期间单次使用50μg芬太尼或0.5mg/kg氯胺酮可减少镇静所需的丙泊酚剂量。然而，与添加芬太尼不同，添加氯胺酮会延长恢复时间。因此，50μg芬太尼是丙泊酚输注用于EUS镇静的良好添加剂，可减少丙泊酚需求且不影响恢复时间。
