Clinical Efficacy of Combination of Propofol and Ketamine (Ketofol) for Deep Sedation in Colonoscopic Procedure

Abstract

AIM: To compare and evaluate the clinical efficacy of the combination of propofol and ketamine (ketofol) versus propofol alone when each regimen is used as sedative agents for colonoscopy. METHODS: 100 patients who underwent colonoscopy in two years, were randomly assigned to PN and PK groups. 50 patients in group PN received propofol and normal saline and 50 patients in group PK received propofol and ketamine for deep sedation. All patients were premedicated with 0.02-0.03 mg/kg of midazolam. Immediately after the procedure, the endoscopist was asked to rate tolerability for the patient, discomfort during insertion and satisfaction. As well, a blinded member of the research team evaluated the patient satisfaction, procedural pain, recovery time and recovery score. The primary outcome was the successfully completed colonoscopic procedure. The secondary outcome variables were patient tolerance, discomfort during insertion, patient and endoscopist satisfaction, recovery time and recovery score, hemodynamic parameters, as well as adverse events during and immediately after procedure. RESULTS: All endoscopies were completely successfully. Mean total dose of midazolam in group PK and PN was 0.027±0.005 mg/kg and 0.026±0.005 mg/kg, respectively (p=0.469). Mean total dose of propofol in group PK and PN was 7.28±3.03 mg/kg/h and 8.02±2.99 mg/kg/h, respectively (p=0.451). Mean total dose of ketamine in group PK was 1.49±0.61 mg/kg/h. There were no significant differences in the patient and endoscopist satisfaction, procedural pain and recovery time, but the recovery score at 30 min post-procedure in group PK was significantly lower than group PN (p=0.025). Tolerability of the patient and comfort during insertion in group PN were statistically significantly lower than the patients in group PK. Overall and sedation-related adverse event rate in group PN were also significantly higher than in group PK. However, these adverse events were transient and easily treated with no sequelae. CONCLUSION: Deep sedation in both regimens provided effective and safe for colonoscopy. No serious adverse events were observed. However, the combination of propofol and ketamine (ketofol) used as sedative agents for deep sedation had significantly higher efficacy than the propofol alone.