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CNS & Neurological Disorders - Drug Targets

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ISSN (Print): 1871-5273
ISSN (Online): 1996-3181

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Clinical Trial

Comparison of the Sedative Effect of Ketamine, Magnesium Sulfate, and Propofol in Patients Undergoing Upper Gastrointestinal Endoscopy: Double-Blinded Randomized Clinical Trial

Author(s): Hamed Shafiee, Farahnaz Riahipour, Ahmad Hormati, Sajjad Ahmadpour*, Mohammad Amin Habibi, Mostafa Vahedian, Reza Aminnejad and Mohammad Saeidi*

Volume 22, Issue 8, 2023

Published on: 14 October, 2022

Page: [1259 - 1266] Pages: 8

DOI: 10.2174/1871527321666220831093652

open access plus

Abstract

Background: Endoscopy provides valuable diagnostic information and intervention therapies for gastroenterologists. Therefore, various drugs have been used to induce sedation in patients undergoing endoscopy, whereas none have been considered preferred by endoscopists. In the current study, we decided to use the combination of magnesium sulfate, ketamine, and their synergistic effects for creating partial analgesia to increase the satisfaction of endoscopists and patients.

Methods: This study is a Double-Blind Randomized Clinical Trial that investigates the sedative effect of ketamine, magnesium sulfate, and propofol in endoscopy. Patients were selected from individuals over 12 years old and with American Society of Anesthesia (ASA) physical status I or II. The study was performed on 210 patients classified as ASA (I have no underlying disease) or II (with underlying controlled disease). The whole group was relieved of pain through sedation according to Ramsay criteria, satisfaction with the operation, duration, recovery, nausea and vomiting, hypotension, and decreased oxygen saturation were compared.

Results: A total of 155 patients were enrolled in our study, including 51 patients (midazolam and propofol), 55 patients (midazolam and ketamine), and 49 patients (midazolam and ketamine and magnesium). The results showed that preoperative heart rate, intraoperative systolic blood pressure, intraoperative diastolic blood pressure, postoperative heart rate, postoperative systolic blood pressure, and postoperative heart rate were significantly different between the groups.

Conclusion: The satisfaction of the endoscopic was achieved to a great extent, mainly in the group receiving midazolam and propofol and in the group receiving midazolam and ketamine. In most cases, the satisfaction of the endoscopic was acceptable, and the low satisfaction of the endoscopic was more in the group receiving midazolam. Ketamine and magnesium were observed. The two compounds midazolam-ketamine, and midazolam-propofol, have a more favorable effect than the combination of midazolam, ketamine, and magnesium.

Keywords: GI endoscopy, sedation, patient satisfaction, magnesium sulfate, ketamine, midazolam, propofol

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[1]
Network SIG. SIGN Guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Paediatr Anaesth 2008; 18(1): 11-2.
[PMID: 18095959]
[2]
Sivak MV. Gastrointestinal endoscopy: past and future. Gut 2006; 55(8): 1061-4.
[http://dx.doi.org/10.1136/gut.2005.086371] [PMID: 16849338]
[3]
Dilos BM. Anesthesia for pediatric airway endoscopy and upper gastrointestinal endoscopy. Int Anesthesiol Clin 2009; 47(3): 55-62.
[http://dx.doi.org/10.1097/AIA.0b013e3181aeabf5] [PMID: 19590286]
[4]
Bowton DL, Scuderi PE, Harris L, Haponik EF. Pulse oximetry monitoring outside the intensive care unit: Progress or problem? Ann Intern Med 1991; 115(6): 450-4.
[http://dx.doi.org/10.7326/0003-4819-115-6-450] [PMID: 1872492]
[5]
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists Practice guidelines for sedation and analgesia by non-anesthesiologists Anesthesiology 2002; 96(4): 1004-17.
[http://dx.doi.org/10.1097/00000542-200204000-00031] [PMID: 11964611]
[6]
Greff M. Colorectal cancer screening in France: Guidelines and professional reality. Endoscopy 1999; 31(6): 471.
[http://dx.doi.org/10.1055/s-1999-38] [PMID: 10494689]
[7]
Ristikankare M, Hartikainen J, Heikkinen M, Janatuinen E, Julkunen R. Is routinely given conscious sedation of benefit during colonoscopy? Gastrointest Endosc 1999; 49(5): 566-72.
[http://dx.doi.org/10.1016/S0016-5107(99)70383-4] [PMID: 10228253]
[8]
Lieberman DA, Wuerker CK, Katon RM. Cardiopulmonary risk of esophagogastroduodenoscopy. Role of endoscope diameter and systemic sedation. Gastroenterology 1985; 88(2): 468-72.
[http://dx.doi.org/10.1016/0016-5085(85)90508-6] [PMID: 3965335]
[9]
Early DS, Lightdale JR, Vargo JJ II, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87(2): 327-37.
[http://dx.doi.org/10.1016/j.gie.2017.07.018] [PMID: 29306520]
[10]
Kashani P, Yousefian S, Amini A, Heidari K, Younesian S, Hatamabadi HR. The effect of intravenous ketamine in suicidal ideation of emergency department patients. Emergency (Tehran) 2014; 2(1): 36-9.
[PMID: 26495340]
[11]
Herroeder S. Schِönherr ME, De Hert SG, Hollmann MW, Warner DS. Magnesium essentials for anesthesiologists. Anesthesiology 2011; 114(4): 971-93.
[http://dx.doi.org/10.1097/ALN.0b013e318210483d] [PMID: 21364460]
[12]
Morrison AP, Hunter JM, Halpern SH, Banerjee A. Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: A systematic review and meta-analysis. Br J Anaesth 2013; 110(5): 702-12.
[http://dx.doi.org/10.1093/bja/aet064] [PMID: 23533255]
[13]
Jahangiri L, Kesmati M, Najafzadeh H. Evaluation of analgesic and anti-inflammatory effect of nanoparticles of magnesium oxide in mice with and without ketamine. Eur Rev Med Pharmacol Sci 2013; 17(20): 2706-10.
[PMID: 24174350]
[14]
VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006; 101(10): 2209-17.
[15]
Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol 2000; 95(6): 1476-9.
[http://dx.doi.org/10.1111/j.1572-0241.2000.02080.x] [PMID: 10894582]
[16]
Amini A, Arhami Dolatabadi A, Kariman H, et al. Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination vs. regular dose propofol and fentanyl combination for deep sedation induction; A randomized clinical trial. Emergency (Tehran) 2018; 6(1): e57.
[PMID: 30584573]
[17]
Vuckovic S, Srebro D, Medic B, Stojanovic R, Vucetic C, Prostran A. A synergistic interaction between magnesium sulphate and ketamine on the inhibition of acute nociception in rats. Eur Rev Med Pharmacol Sci 2015; 19(13): 2503-9.
[18]
Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr 2012; 54(3): 422-6.
[http://dx.doi.org/10.1097/MPG.0b013e3182323c75] [PMID: 21857244]
[19]
Kayaaltı S, KayaaltıÖ Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy. World J Clin Cases 2018; 6(16): 1146-54.
[http://dx.doi.org/10.12998/wjcc.v6.i16.1146] [PMID: 30613673]
[20]
Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis. Anaesthesia 2013; 68(1): 79-90.
[http://dx.doi.org/10.1111/j.1365-2044.2012.07335.x] [PMID: 23121612]
[21]
Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: Up-to-date indications for primary care providers. Int J Gen Med 2010; 3: 345-57.
[http://dx.doi.org/10.2147/IJGM.S14555] [PMID: 21116340]
[22]
Gómez Zuleta MA, Ruiz Morales ÓF, Riveros J. Diagnostic usefulness of upper gastrointestinal endoscopy for patients under 18 years of age. Rev Colomb Gastroenterol 2014; 29(2): 112-6.
[23]
Lin OS. Sedation for routine gastrointestinal endoscopic procedures: A review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 2017; 15(4): 456-66.
[http://dx.doi.org/10.5217/ir.2017.15.4.456] [PMID: 29142513]
[24]
Eskander AE, Baroudy NR, Refay AS. Ketamine sedation in gastrointestinal endoscopy in children. Open Access Maced J Med Sci 2016; 4(3): 392-6.
[http://dx.doi.org/10.3889/oamjms.2016.085] [PMID: 27703561]
[25]
Takzare A, Soltani AE, Maleki A, et al. Comparison of propofol-ketamine vs. propofol-fentanyl for pediatric sedation during upper gastrointestinal endoscopy. Arch Anesthesiol Crit Care 2016; 2(3): 222-5.
[26]
Algharabawy WS, Abusinna RG. AbdElrahman TN. Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study). Egypt J Anaesth 2021; 37(1): 364-72.
[http://dx.doi.org/10.1080/11101849.2021.1961428]
[27]
Zaher ONH, El Kabarity RH, Ali RMM, Mohamed MM. Dexmedetomidine versus ketamine-propofol for sedation of obese patients undergoing upper gastrointestinal endoscopy. QJM: An International Journal of Medicine 2021; 114(1): 92.
[http://dx.doi.org/10.1093/qjmed/hcab086.092]
[28]
Tosun Z, Aksu R, Guler G, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth 2007; 17(10): 983-8.
[http://dx.doi.org/10.1111/j.1460-9592.2007.02206.x] [PMID: 17767636]
[29]
Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth 2005; 17(3): 187-90.
[http://dx.doi.org/10.1016/j.jclinane.2004.06.019] [PMID: 15896585]
[30]
Kim JE, Shin CS, Lee YC, Lee HS, Ban M, Kim SY. Beneficial effect of intravenous magnesium during endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 2015; 29(12): 3795-802.
[http://dx.doi.org/10.1007/s00464-015-4514-1] [PMID: 26335078]

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