Comparison of Propofol Alone and Propofol-Ketamine Mixture for Sedation during Endoscopic Retrograde Cholangiopancreatography (ERCP): A Randomised Study

Abstract

Introduction: Propofol is frequently used for deep sedation for Endoscopic Retrograde Cholangiopancreatography (ERCP). Sedation-Related Adverse Events (SRAEs), associated with propofol administration, include hypotension, arrhythmia, oxygen desaturation, unplanned intubation and procedure termination whereas, ketamine propofol combination has favourable haemodynamic effects. Aim: To evaluate the efficacy of the synergistic effect of small dose of ketamine (25 mg) and propofol in comparison with propofol alone on propofol consumption for deep sedation in patients undergoing ERCP. Materials and Methods: A total of 60 patients undergoing ERCP were randomly assigned to one of the two medication regimens through chit and box method. Patients in Group 1 (n=30) received only intravenous propofol, while patients in Group 2 (n=30) received 25 mg of i.v. ketamine along with intravenous propofol and both groups of patients were titrated to achieve deep sedation. Total propofol consumption was recorded in both groups. Results: Patients in both groups were comparable in terms of BMI, ASA status and duration of ERCP. Group 1 patients required significantly higher doses of propofol (370±123.4 mg) as compared with Group 2 (342.65±116.4 mg). The mean percentage decline in oxygen saturation during the procedure was greater in Group 1 than it was in Group 2. Conclusion: Authors concluded that during ERCP addition of ketamine to propofol resulted in decrease in propofol consumption without disturbing intra and post-procedure haemodynamic stability.

Keywords

• consumption
• endoscopic retrograde
• ramsay sedation