Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography.
Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography.
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DOI：
10.4097/kjae.2018.71.1.43
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发表时间：
2018-03
影响因子：
2.9
通讯作者：
Bhatia V
中科院分区：
文献类型：
--
作者：
Singh SA;Prakash K;Sharma S;Dhakate G;Bhatia V
我们评估了添加小剂量的氯胺酮或芬太尼是否会导致异丙酚总消耗剂量减少，而不影响接受内镜超声检查（EUS）的患者的安全性和康复。该研究共纳入 210 名在镇静状态下接受选择性 EUS 的成年患者。患者被随机分为三组。第1组患者术前静脉注射生理盐水，第2组患者静脉注射50μg芬太尼，第3组患者静脉注射0.5mg/kg氯胺酮。所有患者均接受静脉注射异丙酚镇静。记录异丙酚消耗量（mg/kg/h）。记录低血压、心动过缓、饱和度降低和咳嗽的发生率。还记录了麻醉后出院评分 (PADS) 达到 10 的时间。第 1 组有 68 名患者，第 2 组有 70 名患者，第 3 组有 72 名患者。第 1 组消耗的异丙酚量 (9.25 [7.3–13.2]) 显着高于第 2 组 (8.8 [6.8–12.2]) 和第 3 组 (7.6 [5.7–9.8])。所有组中患者的血流动力学和氧合状况均保持良好且具有可比性。与其他两组相比，第 3 组达到 PADS 10 的时间明显更长。在 EUS 期间单剂量使用 50 µg 芬太尼或 0.5 mg/kg 氯胺酮可减少镇静所需的异丙酚剂量。然而，与添加芬太尼不同，添加氯胺酮会增加恢复时间。因此，50 µg 芬太尼是 EUS 期间镇静丙泊酚输注的良好添加剂，可减少对丙泊酚的需求，而不影响恢复时间。
We evaluated whether the addition of a small dose of ketamine or fentanyl would lead to a reduction in the total dose of propofol consumed without compromising the safety and recovery of patients having endoscopic ultrasonography (EUS). A total of 210 adult patients undergoing elective EUS under sedation were included in the study. Patients were randomized into three groups. Patients were premedicated intravenously with normal saline in group 1, 50 µg fentanyl in group 2, and 0.5 mg/kg ketamine in group 3. All patients received intravenous propofol for sedation. Propofol consumption in mg/kg/h was noted. The incidence of hypotension, bradycardia, desaturation, and coughing was noted. The time to achieve a Post Anesthesia Discharge Score (PADS) of 10 was also noted. There were 68 patients in group 1, 70 in group 2, and 72 in group 3. The amount of propofol consumed was significantly higher in group 1 (9.25 [7.3–13.2]) than in group 2 (8.8 [6.8–12.2]) and group 3 (7.6 [5.7–9.8]). Patient hemodynamics and oxygenation were well maintained and comparable in all groups. The time to achieve a PADS of 10 was significantly higher in group 3 compared to the other two groups. The use of 50 µg fentanyl or 0.5 mg/kg ketamine in a single dose during EUS reduces the dose of propofol required for sedation. However, unlike the addition of fentanyl, the addition of ketamine increased the time to recovery. Thus, 50 µg fentanyl is a good additive to propofol infusion for sedation during EUS to reduce the requirement for propofol without affecting the time to recovery.