Aug 2026· Düzce Tıp Fakültesi Dergisi· Vol 28, pp. 200-206· 0 citations· 20 references
TL;DR
Ketofol sedation was independently associated with a lower risk of hypoxemia than propofol alone in patients undergoing advanced endoscopic procedures, suggesting that ketofol may offer a potential respiratory safety advantage, although prospective randomized studies are needed to confirm this association.
Abstract
Aim: Advanced endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation, during which respiratory complications remain a major concern. This study aimed to compare the effects of propofol and a ketamine–propofol combination (ketofol) on hypoxemia and airway intervention.Material and Methods: This retrospective, single-center observational study included 125 adult participants who underwent EUS or ERCP and received either propofol (n=63) or ketofol (n=62) sedation. The primary outcome was hypoxemia, defined as peripheral oxygen saturation (SpO₂) <90% sustained for at least 10 seconds, and the secondary outcome was the requirement for an airway intervention. Clinical, procedural, and sedation-related variables were analyzed.Results: Hypoxemia occurred in 18 (28.6%) participants in the propofol group and 9 (14.5%) participants in the ketofol group (p=0.056). The lowest recorded SpO₂ was lower in the propofol group than in the ketofol group (91.2±4.8% vs 93.6±3.9%, p=0.003). Airway intervention was required in 14 (22.2%) and 6 (9.7%) participants, respectively (p=0.056). Ketofol sedation was independently associated with a lower risk of hypoxemia (adjusted odds ratio: 0.42, 95% confidence interval: 0.18-0.98, p=0.044). Older age, higher body mass index, American Society of Anesthesiologists physical status class III-IV, and longer procedure duration were independently associated with an increased risk of hypoxemia.Conclusion: Ketofol sedation was independently associated with a lower risk of hypoxemia than propofol alone in patients undergoing advanced endoscopic procedures. These findings suggest that ketofol may offer a potential respiratory safety advantage, although prospective randomized studies are needed to confirm this association.
Sedation during advanced endoscopic procedures is associated with an increased risk of respiratory complications, particularly in obese patients. This study aimed to compare respiratory complications between obese and non-obese patients undergoing advanced endoscopic procedures under sedation and to identify independent predictors of these complications. In this retrospective, single-center cohort study, a total of 104 patients who underwent EUS and/or ERCP under sedation were included. Patients were categorized as obese (BMI ≥30 kg/m², n=52) and non-obese (BMI <30 kg/m², n=52). The primary outcome was hypoxemia (SpO₂ <90%). Secondary outcomes included apnea, airway intervention, and other periprocedural complications. Multivariable logistic regression analysis was performed to identify independent predictors of respiratory complications. Hypoxemia was observed more frequently in obese patients compared to non-obese patients (30.8% vs 15.4%, p=0.048). The lowest recorded SpO₂ values were lower in the obese group (90.8 ± 5.1 vs 93.4 ± 4.2, p=0.006). Airway intervention was required more frequently in obese patients (25.0% vs 11.5%, p=0.048). In multivariable analysis, obesity (OR: 2.18, 95% CI: 1.02-4.66, p=0.044), age, ASA class, and procedure duration were identified as independent predictors of respiratory complications. Sedation strategy was not significantly associated with the outcome. Obesity was identified as an independent risk factor for respiratory complications during advanced endoscopic procedures under sedation. These findings highlight the importance of individualized sedation planning and close respiratory monitoring in obese patients.
Ali Ümit Eşbah, Serkan Torun· Health Sciences Quarterly· 0 citations
Both agents are effective for short procedural sedation, whereas propofol ensures faster recovery, and Dexmedetomidine offers superior cardiorespiratory stability, whereas propofol ensures faster recovery.
Vikash Gaurav· International Journal of Pha...· 0 citations
Background/Aims
The current study aimed to evaluate the effects of intravenous (IV) lidocaine on sedative requirements, duodenal peristalsis, and procedural outcomes in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under deep sedation.
Materials and Methods
In this prospective, randomized, double-blind, placebo controlled study, 120 patients with ASA I-III who were scheduled for elective ERCP were enrolled. Participants were randomized to 2 groups: the lidocaine group (n = 60) received a 1 mg/kg bolus followed by a 2 mg/kg/h infusion, whereas the control group (n = 60) received an equivalent volume of 0.9% saline. Sedation was maintained with propofol and titrated to a Bispectral Index of 60-80. Duodenal peristalsis was assessed using a predefined semiquantitative peristalsis scoring system.
Results
Demographic characteristics were similar between groups. Total propofol consumption was significantly lower in the lidocaine group (P < .001). Recovery and discharge times were significantly shorter in the lidocaine group than in the control group (P < .001 for both). Clinically adequate inhibition of duodenal peristalsis was observed more frequently in the lidocaine group (90.0% vs. 75.0%; P = .031), and the requirement for rescue antispasmodics was lower (P = .018). Complication rates, cannulation time, primary success rate, and endoscopist satisfaction were similar between groups.
Conclusion
IV lidocaine may serve as a supportive anesthetic-sparing adjunct during ERCP, reducing propofol requirements and facilitating shorter recovery times. Although lidocaine was associated with greater inhibition of duodenal peristalsis and reduced use of rescue antispasmodic, major procedural outcomes were comparable between groups; therefore, these findings should be interpreted cautiously.
Mehmet Şahap, Önder Aydemir, Kerem Kenarlı et al.· The Turkish Journal of Gastr...· 0 citations
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery.
Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed.
Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09).
Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
AVINASH KAREKAL, SRINIVAS KURAHATTI, Rashmi C· Asian Journal of Pharmaceuti...· 0 citations
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation and analgesia. Ketamine–propofol and ketamine–midazolam is commonly used, but comparative data in ERCP are limited.
Objective: To compare the effectiveness and safety of ketamine–propofol (KP) versus ketamine–midazolam (KM) for procedural sedation during ERCP.
Methods: This prospective observational study included 50 ASA I–II patients aged 18–70 years undergoing ERCP, equally allocated to two groups. The KP group received ketamine–propofol 1:1 (0.5 mg/kg loading dose, 2–3 mg/kg/h infusion). The KM group received ketamine 0.5 mg/kg plus midazolam 0.02 mg/kg, with supplemental doses as required. Sedation was targeted to a Ramsay score of 5. Time to achieve targeted Ramsey Sedation Score after induction, patient needing rescue sedation, hemodynamic variables, recovery time, and adverse events were recorded. Data were analyzed using t-tests and chi-square tests, with P < 0.05 considered significant.
Results: Group KP achieved faster sedation than Group KM (184.80 ± 48.74 vs. 314.40 ± 92.11 seconds; P value < 0.001) and shorter recovery time (7.92 ± 1.89 vs. 9.48 ± 2.25 min; P value < 0.05). Discharge time was similar between groups. Hemodynamic parameters were lower in the KP group after induction. Desaturation and airway maneuvers were more frequent with KP while post procedure nausea and vomiting and recovery agitation were more common with KM group, though not statistically significant.
Conclusion: Both regimens were effective for ERCP sedation. Ketamine–propofol provided faster onset, quicker recovery and better hemodynamic control, but with more respiratory adverse events.
Bibek Shrestha, Samir Shakya, Jeevan Singh et al.· Nepal Journal of Medical Sci...· 0 citations
Background:Functional Endoscopic Sinus Surgery (FESS) requires a clear and bloodless surgical field for optimal visualization and prevention of intraoperative complications. Controlled hypotension is commonly employed during FESS to reduce blood loss and improve surgical conditions. Dexmedetomidine and Propofol are widely used agents for controlled hypotensive anesthesia. The present study was conducted to compare the efficacy of dexmedetomidine and propofol infusion in achieving controlled hypotension during FESS.Methodology:This prospective randomized comparative study was conducted in the Department of Anaesthesiology at Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 100 patients aged between 18 and 40 years belonging to ASA Grade I and II undergoing elective FESS were included in the study. Patients were randomly allocated into two groups of 50 each. Group D received dexmedetomidine infusion at 0.4–0.8 μg/kg/hr, while Group P received propofol infusion at 75–100 μg/kg/min following induction of general anesthesia. Intraoperative pulse rate, mean arterial pressure, blood loss, quality of surgical field, sedation score, and complications were assessed and compared between the two groupsResults:Baseline demographic and hemodynamic parameters were comparable between the groups. Intraoperative pulse rate and mean arterial pressure were significantly lower in the dexmedetomidine group at various time intervals compared with the propofol group (p<0.05). Quality of surgical field and mean blood loss were comparable in both groups. Postoperative Ramsay sedation scores at 30 minutes were significantly higher in the propofol group (p=0.023). No major complications were observed in either group.Conclusion:Both dexmedetomidine and propofol were effective and safe agents for controlled hypotension during FESS. Dexmedetomidine provided superior intraoperative hemodynamic stability with comparable surgical field quality and blood loss, making it a useful alternative to propofol for hypotensive anesthesia in endoscopic sinus surgery.
Dr. Balakrishnan, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations