The Efficacy of Etomidate-Fentanyl versus Dexmedetomidine-Ketamine for Procedural Sedation and Analgesia during Upper Endoscopy and Biopsy: A Prospective, Randomized Study

Nagat S El Shmaa

doi:10.4172/2155-6148.1000480

Abstract

Objective: To assess the effectiveness of a combination of etomidate-fentanyl versus dexmedetomidineketamine for Procedural Sedation and Analgesia (PSA) in patients undergoing upper endoscopy and biopsy. Patients and methods: This is a prospective randomized observer-blinded study. This study was carried out in Tanta university hospital on 100 patients of both sexes; ASA physical status I and II, age range from 20-60 years undergone upper endoscopy and biopsy. All patients were randomly divided into two groups (each group 50 patients) Group E (etofen): patients received an initial IV bolus dose of etomidate 0.15 mg/kg + fentanyl 1 mcg/kg IV, followed by etomidate infusion at 0.01-0.03 mg/kg/min. Group D (dexmedetomidine-ketamine): patients received an initial IV bolus dose of dexmedetomidine (1 μg/kg) +ketamine (1 mg/kg) followed by dexmedetomidine infusion (0.5-1 μg/kg/hr) with supplemental bolus doses of ketamine (0.5 mg/kg) as needed. Sedation started and adjusted according to bispectral index level (BIS) range 60-80. Patients were then observed by an anesthesiologist who was blinded about sedative/analgesic received. The primary outcomes were onset, level and time of sedation and the secondary outcomes were recovery time, Length of recovery room (RR) stay (min), duration of hospital stay, VAS score, hemodynamic changes (HR, MBP, SPO2, RR), surgeon satisfaction, side effects, and patient satisfaction. Results: There was significant rapid onset of sedation in group E as compared to group D, Sedation level by BIS, showed significant increase (P<0.05) in group E in comparison with group D. Recovery time, Length of recovery room (RR) stay (min) and Length of hospital stay (hr) showed significant decrease (P<0.05) in group E in comparison with group D. Conclusion: The etomidate/fentanyl combination provides an effective and safe procedural sedation and analgesia for upper endoscope and biopsy. Etomidate/Fentanyl combination provides shorter sedation times and lighter sedation level (but enough for the procedure) when compared to the dexmedetomidine/ketamine combination.

Highlights

Procedural sedation and analgesia defines as the technique of administering sedatives or dissociative agents with or without analgesics to induce an altered state of consciousness that allows the patient to tolerate painful or unpleasant procedures while preserving cardiorespiratory function [1].There is no ideal drug for analgesia and sedation during Gastrointestinal (GIT) endoscopy
This is a prospective randomized observer blinded study conducted at Tanta university hospital and carried out on 100 adult patients of both sex’s undergone upper endoscopy and biopsy during the period from April 2011 to February 2013 after approval by the hospital Ethical Committee
Myoclonus was significantly higher in group E (16%) in comparison with group D (2%) (p

Summary

Introduction

Procedural sedation and analgesia defines as the technique of administering sedatives or dissociative agents with or without analgesics to induce an altered state of consciousness that allows the patient to tolerate painful or unpleasant procedures while preserving cardiorespiratory function [1]. There is no ideal drug for analgesia and sedation during Gastrointestinal (GIT) endoscopy. Providing adequate sedation/ analgesia regimen through drug combination is an art. Targeting a moderate level of sedation that gives a better safety margin than deeper level [2,3]. Level of sedation/analgesia in endoscopy depends on the procedure; in rigid or flexible, diagnostic uncomplicated upper endoscopies moderate sedation is enough. While in prolonged or complex procedures (e.g. ERCP) deeper levels of sedation may be required [4]

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Conclusion