Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA.
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2024 Jan 23;189(1-2):313-320. doi: 10.1093/milmed/usac183.
Ketamine is an effective sedative agent in a variety of settings due to its desirable properties including preservation of laryngeal reflexes and lack of cardiovascular depression. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens for patients undergoing endoscopy.
We conducted a randomized controlled trial comparing ketamine to SMS for outpatient colonoscopy or esophagogastroduodenoscopy at Brooke Army Medical Center. The ketamine group received a 1-mg dose of midazolam along with ketamine, whereas the SMS group received midazolam/fentanyl. The primary outcome was patient satisfaction measured using the Patient Satisfaction in Sedation Instrument, and secondary outcomes included changes in hemodynamics, time to sedation onset and recovery, and total medication doses.
Thirty-three subjects were enrolled in each group. Baseline characteristics were similar. Endoscopies were performed for both diagnostic and screening purposes. Ketamine was superior in the overall sedation experience and in all analyzed categories compared to the SMS group (P = .0096). Sedation onset times and procedure times were similar among groups. The median ketamine dose was 75 mg. The median fentanyl and midazolam doses were 150 mcg and 5 mg, respectively, in SMS. Vital signs remained significantly closer to the physiological baseline in the ketamine group (P = .004). Recovery times were no different between the groups, and no adverse reactions were encountered.
Ketamine is preferred by patients, preserves hemodynamics better than SMS, and can be safely administered by endoscopists. Data suggest that ketamine is a safe and effective sedation option for patients undergoing esophagogastroduodenoscopy or colonoscopy (clinicaltrials.gov NCT03461718).
由于其理想的特性，包括保留喉反射和无心血管抑制作用，氯胺酮在各种环境中都是一种有效的镇静剂。我们假设氯胺酮是接受内镜检查患者标准中度镇静（SMS）方案的有效替代方案。
我们在 Brooke 陆军医疗中心进行了一项随机对照试验，比较了氯胺酮与 SMS 用于门诊结肠镜检查或食管胃十二指肠镜检查。氯胺酮组接受 1 毫克咪达唑仑加氯胺酮，而 SMS 组接受咪达唑仑/芬太尼。主要结局是使用镇静患者满意度量表评估的患者满意度，次要结局包括血流动力学变化、镇静起效和恢复时间以及总药物剂量。
每组纳入 33 名受试者。基线特征相似。内镜检查用于诊断和筛查目的。与 SMS 组相比，氯胺酮在整体镇静体验和所有分析类别中均具有优势（P = .0096）。组间镇静起效时间和手术时间相似。氯胺酮的中位剂量为 75 mg。在 SMS 中，芬太尼和咪达唑仑的中位剂量分别为 150 mcg 和 5 mg。生命体征在氯胺酮组更接近生理基线（P = .004）。组间恢复时间无差异，且未发生不良反应。
患者更喜欢氯胺酮，比 SMS 更好地维持血流动力学，并且可以由内镜医生安全给药。数据表明，氯胺酮是接受食管胃十二指肠镜检查或结肠镜检查患者的一种安全有效的镇静选择（clinicaltrials.gov NCT03461718）。
