Ketamine -Propofol For Sedation Of Obese Patients Undergoing Upper Gastrointestinal Endoscopy

Abstract

Introduction: Gastrointestinal endoscopy is a prevalent method for diagnosis as well as therapy for several problems. Propofol is frequently used for sedation; however, its negative effects are reduced by the addition of ketamine. Ketamine an NMDA receptor antagonist and it prevents undesirable effects of using propofol especially in obese patients 
Aim: This investigation was performed to compare and assess the efficiency of the combination of ketamine and propofol (ketofol) vs propofol alone as sedative medications for obese cases having upper gastrointestinal endoscopy.
Patients and methods: 80 cases aged between twenty-one and fifty years, with American Society of Anesthesiologists status II Obese with BMI > 30 planed for elective upper gastrointestinal endoscopy under sedation in the department of internal medicine at Al Zahra University hospital. Medical Ethical Committee was done and following case written consents, patients randomly assigned by computer generated random number into 2 groups (40 in each group).
 Group (P): patient will receive 50 μg fentanyl followed by propofol 2 milligrams per kilogram in boluses manner
Group (KF): patient will receive intravenous propofol–ketamine 3:1 mixture
Results: The total propofol consumption was significantly more in group P than in group KF (258.75 ± 9.041 milligrams and 177.63 ± 63.43 mg, respectively). The recovery duration has been extended in group KF than group P, with times of 6.63 ± 0.628 minutes and 4.85 ± 1.309 minutes, correspondingly. Vomiting attacks were less frequent in group P than group KF; nevertheless, an insignificant distinction has been observed in case and doctor satisfaction scores among both groups (P=0.122). Furthermore, an insignificant distinction among both groups concerning sex, age, heart rate, BMI, and complications such as bradycardia and nausea.
Conclusion: ketofol (Propofol ketamine combination) is associated with higher safety and cardiovascular stability than propofol group without significant adverse effects in obese patients undergoing upper gastrointestinal endoscopy.