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Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients

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Abstract

Background and aims

In this study, we compared duration for reaching desired Ramsay Sedation Score (RSS) and postoperative recovery according to Modified Aldrete Score (MAS) of propofol and propofol-ketamine combination in a group of colonoscopy patients. Rates of cardiovascular, respiratory, laryngospasm, visual and nausea/vomiting complications were also compared as secondary outcomes.

Methods

This is a double-blinded prospective randomized controlled trial. 95 patients were included and blocked randomized to either propofol (GroupP, n: 47) or propofol-ketamine (GroupPK, n: 48). GroupP patients received 0.5 mg/kg propofol and GroupPK received 0.5 mg/kg ketamine-propofol. Subjects were monitorized noninvasively preoperatively and every 5 min during procedure. RSS was recorded for every minute before starting procedure and for every 5 min during procedure. Recovery after colonoscopy was evaluated according to MAS. Same observer checked for MAS just after procedure in postoperative 1 min and for every 3 min during follow-up. Postoperative respiratory depression was defined as rate <10/min, hypercapnia/hypercarbia—arterial CO2 tension >50 mmHg or SO2 <90 while hypotension was defined as a decrease of 20 % in mean blood pressure compared to initial values.

Results

GroupPK patients needed shorter duration for achieving RSS ≥ 4 (p: 0.038) but longer duration for achieving MAS ≥ 9 (p: 0.005). GroupP’s intraoperative blood pressures and heart rates were significantly lower compared to initial values. We observed that respiratory depression (19.1 vs 0 %, p: 0.001), hypotension (29.8 vs 10.4 %, p: 0.018), and nausea/vomiting (17 vs 4.2 %, p: 0.041) were significantly more common in GroupP.

Conclusion

Propofol-ketamine combination is an advantageous choice in means of achieving sedation in a shorter period of time, a better hemodynamic stability, less nausea and vomiting and respiratory complication rates. Yet it seems that this choice might be related with longer recovery duration.

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Authors and Affiliations

  1. Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey

    Z. Baykal Tutal, H. Gulec, N. Derelı, M. Babayıgıt, A. Kurtay, H. Inceoz & E. Horasanlı

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  1. Z. Baykal Tutal
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  2. H. Gulec
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  3. N. Derelı
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  4. M. Babayıgıt
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  5. A. Kurtay
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  6. H. Inceoz
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  7. E. Horasanlı
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Correspondence to Z. Baykal Tutal.

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Baykal Tutal, Z., Gulec, H., Derelı, N. et al. Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients. Ir J Med Sci 185, 699–704 (2016). https://doi.org/10.1007/s11845-015-1348-8

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  • DOI: https://doi.org/10.1007/s11845-015-1348-8

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