Tekeli Arzu Esen, Oğuz Ali Kendal, Tunçdemir Yunus Emre, Almali Necat
Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine.
Department of General Surgery, Van Yuzuncu Yil University School of Medicine, Van, Turkey.
Medicine (Baltimore). 2020 Dec 4;99(49):e23317. doi: 10.1097/MD.0000000000023317.
Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy.
The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses.
In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation.
Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.
右美托咪定和氯胺酮是常用的镇静剂，导致最小程度的呼吸抑制且具有镇痛活性。我们旨在比较右美托咪定-丙泊酚联合用药与氯胺酮-丙泊酚联合用药在上消化道系统内镜检查期间的有效性和安全性。
本研究在获得当地伦理委员会批准后开始。纳入美国麻醉医师协会（ASA）I级和II级、年龄在18至60岁之间的患者。排除患有严重器官疾病、对研究药物过敏以及拒绝参与者。将病例随机分为右美托咪定-丙泊酚组（D组，n = 30）和氯胺酮-丙泊酚组（K组，n = 30）。进行心脏监测、外周血氧饱和度和脑电双频指数（BIS）监测。D组静脉推注1mg/kg右美托咪定 + 0.5mg/kg丙泊酚，然后以0.5μg/kg/h右美托咪定 + 0.5mg/kg/h丙泊酚持续输注。K组静脉推注1mg/kg氯胺酮 + 0.125mL/kg丙泊酚，然后以0.25mg/kg/h氯胺酮 + 0.125mL/kg/h丙泊酚持续输注。采用Ramsay镇静评分（RSS）≥4对患者进行随访。使用均值、标准差、最低和最高频率值以及比值进行描述性统计，并使用SPSS 22.0软件进行统计分析。
K组的恢复时间和平均血压（MBP）值显著更短。此外，咳嗽发生率、脉搏和BIS值高于D组（P < 0.05）。虽然两组在内镜耐受性和内镜医师满意度方面无显著差异，但我们观察到右美托咪定组的镇静水平更舒适。
右美托咪定-丙泊酚和氯胺酮-丙泊酚联合用药因其不同特性可能适用于内镜检查镇静且安全。观察到右美托咪定-丙泊酚联合用药在镇静深度方面更优，氯胺酮-丙泊酚联合用药在早期恢复方面更优。因此，由于血流动力学稳定且不良反应最小，我们建议在上消化道系统内镜检查镇静中使用右美托咪定-丙泊酚联合用药。
