Shafiee Hamed, Riahipour Farahnaz, Hormati Ahmad, Ahmadpour Sajjad, Habibi Mohammad Amin, Vahedian Mostafa, Aminnejad Reza, Saeidi Mohammad
Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran.
MD, Associated Professor of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
CNS Neurol Disord Drug Targets. 2023;22(8):1259-1266. doi: 10.2174/1871527321666220831093652.
Endoscopy provides valuable diagnostic information and intervention therapies for gastroenterologists. Therefore, various drugs have been used to induce sedation in patients undergoing endoscopy, whereas none have been considered preferred by endoscopists. In the current study, we decided to use the combination of magnesium sulfate, ketamine, and their synergistic effects for creating partial analgesia to increase the satisfaction of endoscopists and patients.
This study is a Double-Blind Randomized Clinical Trial that investigates the sedative effect of ketamine, magnesium sulfate, and propofol in endoscopy. Patients were selected from individuals over 12 years old and with American Society of Anesthesia (ASA) physical status I or II. The study was performed on 210 patients classified as ASA (I have no underlying disease) or II (with underlying controlled disease). The whole group was relieved of pain through sedation according to Ramsay criteria, satisfaction with the operation, duration, recovery, nausea and vomiting, hypotension, and decreased oxygen saturation were compared.
A total of 155 patients were enrolled in our study, including 51 patients (midazolam and propofol), 55 patients (midazolam and ketamine), and 49 patients (midazolam and ketamine and magnesium). The results showed that preoperative heart rate, intraoperative systolic blood pressure, intraoperative diastolic blood pressure, postoperative heart rate, postoperative systolic blood pressure, and postoperative heart rate were significantly different between the groups.
The satisfaction of the endoscopic was achieved to a great extent, mainly in the group receiving midazolam and propofol and in the group receiving midazolam and ketamine. In most cases, the satisfaction of the endoscopic was acceptable, and the low satisfaction of the endoscopic was more in the group receiving midazolam. Ketamine and magnesium were observed. The two compounds midazolam-ketamine, and midazolam-propofol, have a more favorable effect than the combination of midazolam, ketamine, and magnesium.
内镜检查为胃肠病学家提供了有价值的诊断信息和干预治疗方法。因此，多种药物已被用于在内镜检查患者中诱导镇静，但尚无一种被内镜医师视为首选。在本研究中，我们决定使用硫酸镁、氯胺酮及其协同作用来产生部分镇痛效果，以提高内镜医师和患者的满意度。
本研究是一项双盲随机临床试验，旨在研究氯胺酮、硫酸镁和丙泊酚在内镜检查中的镇静效果。患者选自12岁以上且美国麻醉医师协会（ASA）身体状况为I或II级的个体。该研究对210例被分类为ASA（I级：无基础疾病）或II级（有基础疾病但病情得到控制）的患者进行。根据拉姆齐标准，通过镇静使整个组缓解疼痛，比较手术满意度、持续时间、恢复情况、恶心呕吐、低血压和氧饱和度降低情况。
我们的研究共纳入155例患者，包括51例（咪达唑仑和丙泊酚）、55例（咪达唑仑和氯胺酮）和49例（咪达唑仑、氯胺酮和镁）。结果显示，术前心率、术中收缩压、术中舒张压、术后心率、术后收缩压和术后心率在各组之间存在显著差异。
在内镜检查满意度方面在很大程度上得以实现，主要是在接受咪达唑仑和丙泊酚的组以及接受咪达唑仑和氯胺酮的组。在大多数情况下，内镜检查满意度是可以接受的，内镜检查满意度较低的情况更多出现在接受咪达唑仑的组中。观察到氯胺酮和镁。咪达唑仑 - 氯胺酮以及咪达唑仑 - 丙泊酚这两种组合比咪达唑仑、氯胺酮和镁的组合具有更有利的效果。
