Ebru Tarıkçı Kılıç, Resul Kahraman
Department of Anesthesiology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Department of Gastroenterology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Ther Clin Risk Manag. 2019 Jun 18;15:755-763. doi: 10.2147/TCRM.S201441. eCollection 2019.
Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate-to-deep conscious sedation. Combinations of ketamine and propofol (ketofol) and of midazolam and meperidine were analyzed using the bispectral index (BIS). There is no research on the use of ketofol on very elderly patients. The aim of this study is to use BIS and offer insight into the use and safety of ketofol sedation for oldest old patients undergoing ERCP. For the ERCP procedure, 168 patients aged 85+ years were enrolled in a 2-year retrospective single center study. Seventy-five patients received midazolam-meperidine (MM) sedation in 2016, while 75 patients received ketofol (KP) sedation in 2018. The two groups were compared for patient data, procedure duration, Ramsay Sedation Score (RSS), heart rate (HR), blood pressure (BP), and pulse oximetry (SpO), BIS, facial pain score (FPS), time to achieve BIS, recovery time, and complications. The total amount of rescue medication was recorded. The two groups did not differ by patient data or procedure duration (>0.05). Group KP had significantly higher systolic and diastolic BP, HR, and SpO values and lower BIS scores than Group MM (=0.0001). The two groups did not differ by time to achieve BIS scores (>0.05). Group KP had significantly fewer complications and a shorter recovery time than Group MM (<0.001). Ketofol induced sedation results in more stable vital signs and fewer complications than the midazolam-meperidine sedation regimen during ERCP in oldest old patients, indicating that ketofol can be an alternative to midazolam-meperidine.
内镜逆行胰胆管造影术（ERCP）需要中度至深度的清醒镇静。使用脑电双频指数（BIS）分析了氯胺酮和丙泊酚（氯胺酮-丙泊酚合剂）以及咪达唑仑和哌替啶的联合使用情况。目前尚无关于在超高龄患者中使用氯胺酮-丙泊酚合剂的研究。本研究的目的是利用BIS并深入了解氯胺酮-丙泊酚合剂镇静在接受ERCP的高龄患者中的使用情况及安全性。对于ERCP手术，168名年龄在85岁及以上的患者纳入了一项为期2年的回顾性单中心研究。2016年，75名患者接受了咪达唑仑-哌替啶（MM）镇静，而2018年，75名患者接受了氯胺酮-丙泊酚合剂（KP）镇静。比较两组患者的数据、手术持续时间、 Ramsay镇静评分（RSS）、心率（HR）、血压（BP）、脉搏血氧饱和度（SpO）、BIS、面部疼痛评分（FPS）、达到BIS的时间、恢复时间和并发症情况。记录抢救药物的总量。两组患者的数据或手术持续时间无差异（>0.05）。与MM组相比，KP组的收缩压、舒张压、HR和SpO值显著更高，BIS评分更低（=0.0001）。两组达到BIS评分的时间无差异（>0.05）。与MM组相比，KP组的并发症显著更少，恢复时间更短（<0.001）。在高龄患者ERCP手术期间，氯胺酮-丙泊酚合剂诱导的镇静比咪达唑仑-哌替啶镇静方案能产生更稳定的生命体征和更少的并发症，表明氯胺酮-丙泊酚合剂可作为咪达唑仑-哌替啶的替代方案。
