Comparison of Fentanyl Citrate-midazolam-propofol and Fentanyl Citrate-ketamine Propofol Combinations with Regards to Efficiency and Safety in Sedation Practices for the ERCP

Abstract

Aims: The objective of our study is to compare the efficiency and safety of fentanyl citrate-midazolam-propofol combination with fentanyl citrate-ketamine-propofol combination used as sedative and analgesic medication in patients undergoing ERCP procedure. Study Design: Randomized and prospective. Place and Duration of Study: Department of Anaesthesiology and Reanimation (Gastroenterology Unit) between June 2009 and June 2010. Methodology: 103 patients undergoing ERCP aged between 20-80 years, ASA I-III, participated in our study. Cases were randomly divided into two groups as group M(n=51) and group K(n=52). Fentanyl citrate 1 µg/kg IV was infused to all patients 5 minutes before the process. Group M: In addition to fentanyl, midazolam 0.04 mg/kg IV and propofol loading dose of 1mg/kg IV and maintenance dose of 4mg/kg/h IV were also infused. Group K: In addition to fentanyl, ketamine 0.5mg/kg IV and propofol loading dose of 1mg/kg IV and maintenance dose of 4mg/kg/h IV were infused as well. At the end of ERCP procedure, propofol infusion was terminated. The time required for the Richmond Alertness-Sedation Scale (RASS) score to reach -1 (recovery period) and its change from -1 to 0 in recovery room (discharge period) and also the development of side effects during the practice were recorded. After recovery period the patients were questioned if they felt pain during the procedure or not. If they felt any, the pain was evaluated according to Visual Analog Scale (VAS) score. Results: Recovery period, discharge period and satisfaction of the endoscopist were similar between the two groups, however cardiovascular and respiratory system parameters were more stable in patients in Group K. Conclusion: Our study pointed that fentanyl citrate-ketamine-propofol combination is probably preferable over fentanyl citrate-midazolam-propofol combination in terms of cardiovascular and respiratory stability during sedation in ERCP procedures.