Efficacy of Sedation for Colonoscopy, A Comparison between Propofol and Ketamine Combination (Ketofol) Versus Propofol and Fentanyl Combination (Fenofol)
Keywords:Ketofo, Fenofol, Ketamine, Propofol, Fentanyl, Colonoscopy, Sedation
Background: Colonoscopy requires anesthesia for patients’ comfort and reduction of abdominal pain.Objectives: To compare the efficacy of ketofol versus fenofol in anesthesia for colonoscopy.Methods: This study was a randomized, double-blind controlled trial. Sixty-four patients aged 18-85 years who underwent colonoscopy in Ubonratchathani Cancer Hospital were randomly assigned to ketofol and fenofol groups. The thirty-two patients in the ketofol group initially received an intravenous bolus injection of ketamine 0.5 mg/ kg and propofol 1 mg/ kg whereas the thirty-two patients in the fenofol group received an intravenous bolus injection of fentanyl 1 mcg/ kg and propofol 1 mg/ kg. Afterwards, whenever a patient’s Ramsay Sedation Score became less than 5, he or she received another injection of 5 ml of the combination used in his or her group. Blood pressure, heart rate, oxygen saturation, Ramsay Sedation Score, total dose of the drug, duration of the procedure, recovery time, postoperative pain, patients satisfaction, and adverse events were recorded.Results: Patients in the ketofol group had significantly higher systolic blood pressure (132±13.48 mmHg), and mean arterial blood pressure (93.03±10.32 mmHg) compared to the systolic blood pressure (124±15.83 mmHg), and mean arterial blood pressure (86.75±11.51 mmHg) of the fenofol group (p=0.025 and p=0.025 respectively). The average Ramsay Sedation Score in the ketofol group was 5.75±0.44, significantly higher than fenofol group, which was 5.38±0.66, (p=0.01). There was a significantly higher number of patients who required airway maneuvers in the fenofol group (10 patients (31.2%)) compared to the ketofol group (3 patients (9.4%)), (p=0.045). Hallucination and nightmares were significantly more common in the ketofol group (4 patients (12.5%)) compared to the fenofol group [None], (p=0.039).Conclusions: Ketofol and fenofol were both effective options for sedation in colonoscopy. The ketofol group required less airway management, but caused more hallucination and nightmares
Amornyotin S, Srikureja W, Pausawasdi N,Prakanrattana U, Kachintorn U. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand. Asian Biomed 2011; 5: 485-91.
Raksamani A. Intravenous anesthetics. In: Suwanchinda V,Phakanrattana U, eds. Siriraj’s text-book of anesthesiology. 2nd ed. Bangkok: Bangkok Wetchasan Printing House; 1995. p 163-175.
Harper NJ. Propofol and food allergy. Br J Anaesth 2016;116:11–3.
Sommerfield DL, Lucas M, Schilling A, Drake-Brockman TFE,Sommerfield A, Arnold A, et al. Propofol use in children with allergies to egg, peanut, soybean or other legumes. Anesthesia 2019;74:1252-9.
Heidari SM, Shetabi HR, TarashiKashani S. Comparison between the effects of propofol-ketamine and propofol-fentanyl for sedation in cataract surgery. Scientific Journal of Kurdistan University of Medical Sciences. 2019; 24:30-40.
Akhondzadeh R, Ghomeishi A, Nesioonpour S, Nourizade S. A comparison between the effects of propofol-fentanyl with propofol-ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating. Biomed J 2016; 39:145-9.
Tutal ZB, Gulec H, Dereli N, Babayigit M, Kurtay A, Inceoz H, 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 2016; 185:699-704.
Kawattikul J, Duangkhamchan R, Butthai S. The efficacy of combination of ketamine and propofol for sedation in colonoscopy. Mahasarakham Hospital Journal 2017; 14:20-9
Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Moharari RS.Conscious sedation and analgesia in colonoscopy: ketamine/propofol combination has superior patient satisfaction versus fentanyl/propofol. Anesth Pain Med 2013; 3: 208-13.
Nazemroaya B, Majedi MA, Shetabi H, Salmani S. Comparison of propofol and ketamine combination (Ketofol) and propofol and fentanyl combination (Fenofol) on quality if sedation and analgesia in the lumpectomy: a randomized clinical trial. Adv Biomed Res 2018; 7:134.
Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, Boyaci A. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Pediatr Anesth 2007;17:983-8.
Riham H, Wael E. Ketamine/propofol versus fentanyl/propofol for sedating obese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Egyptian Journal of Anaesthesia 2013; 29:207-211.
Bahattin T, Yonca Ozavardar P, Arzu C, Pinar Z. Addition of low dose ketamine to midazolam-fentanyl propofol based sedation for colonoscopy: a randomized, double blind, control trial. J Clin Anesth 2015; 27:301-6.
Amornyotin S, kongphlay S. Clinical efficacy of combination of propofol and ketamine (ketofol) for deep sedation in colonoscopic procedure. Journal of Gastroenterology and Hepatology Research 2015; 4:1689-93.
Blagrove M, Morgan CJA, Curran HV, Bromley L, Brandner B. The incidence of unpleasant dreams after sub-anaesthetic ketamine. Psychopharmacology 2008; 203:109-20.
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