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

Abstract

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. 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 0.5mg/kg propofol and GroupPK received 0.5mg/kg ketamine-propofol. Subjects were monitorized noninvasively preoperatively and every 5min during procedure. RSS was recorded for every minute before starting procedure and for every 5min during procedure. Recovery after colonoscopy was evaluated according to MAS. Same observer checked for MAS just after procedure in postoperative 1min and for every 3min during follow-up. Postoperative respiratory depression was defined as rate <10/min, hypercapnia/hypercarbia-arterial CO2 tension >50mmHg or SO2 <90 while hypotension was defined as a decrease of 20% in mean blood pressure compared to initial values. 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. 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.