Background
This study tested the hypothesis that use of ketamine as an adjuvant to propofol in the induction of deep sedation for endoscopy patients could lead, paradoxically, to faster emergence.
Methods
We conducted a single-center, prospective randomized controlled study on 154 adult ASA I or II patients, admitted for gastrointestinal endoscopies. Patients were sedated with 25 µg fentanyl and 1 mg/kg propofol bolus over 30 s. Patients were divided into two groups: Group P ( = 77), sedated with propofol only, and Group PK ( = 77), who received additionally a single dose of ketamine (0.1 mg/kg) at induction. If the patient moved or Ramsay Sedation Score (RSS) regressed to <4, increments of 0.25 mg/kg of propofol were given. After the end of the procedure, emergence from sedation was assessed with modified Aldrete score, 5 and 10 m after admission to the recovery room.
Results
Adding a small dose of ketamine did not significantly achieve deep sedation (RSS ≥4) more quickly or result in lesser propofol increments. Patients who received ketamine showed a statistically significant improvement in the Modified Aldrete score when recorded 5 min after admission to the recovery room (Group P 8.73 ± 1.02, Group PK 9.1 ± 0.96, value = 0.02), but not after 10 min (Group P 9.03 ± 0.74, Group PK 9.21 ± 0.8, value = 0.146).
Conclusion
Inclusion of a small single dose of ketamine in the induction of sedation for gastrointestinal endoscopy significantly improves emergence from sedation.