Jimah Bashiru Babatunde, Appiah Anthony Baffour, Sarkodie Benjamin Dabo, Anim Dorothea
Department of Medical Imaging, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana, Accra, Ghana.
Radiol Res Pract. 2021 Apr 17;2021:6657137. doi: 10.1155/2021/6657137. eCollection 2021.
Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure.
We performed repeated HSG workup under IV ketamine (20-40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21.
A total of 27 patients (age range: 25-48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32-37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation.
This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients' feedback to help assess safety and effectiveness in local settings.
疼痛、焦虑和痛苦在包括子宫输卵管造影术（HSG）在内的放射学检查中很常见。研究表明，镇静可通过缓解焦虑、不适和疼痛，使患者更好地耐受诊断性成像和影像引导操作。本研究旨在评估氯胺酮在HSG中的安全性和有效性，以及使用吉马程序在HSG期间双侧输卵管真性阻塞的比例。
我们在开普海岸教学医院对27名不孕妇女进行了静脉注射氯胺酮（20 - 40 mg/mL）镇静下的重复HSG检查。排除标准包括单侧输卵管阻塞、阴道或宫颈急性感染、活动性阴道出血、青光眼以及研究时的高血压。数据用Microsoft Excel录入，并使用SPSS版本21进行分析。
共有27例先前诊断为双侧输卵管阻塞或痉挛的患者（年龄范围：25 - 48岁）入选重复HSG检查。中位年龄为34岁（四分位间距：32 - 37），其中继发性不孕（20例）（74.1%）是最常见的指征。所有患者在检查期间或检查后均未报告疼痛或痛苦。两名（7.4%）女性在HSG检查后呕吐。12例患者（44.4%）存在双侧输卵管阻塞（真阳性），而在氯胺酮镇静下进行HSG检查时，15例（55.6%）患者输卵管通畅。
本研究发现静脉注射氯胺酮镇静可产生深度麻醉和镇痛作用，并消除输卵管痉挛。我们建议发展中国家的放射科医生应考虑在HSG检查期间为患者进行镇静，并记录观察结果和患者反馈，以帮助评估当地环境中的安全性和有效性。
