Randomized Controlled Trial of Ketamine and Moderate Sedation for Outpatient Endoscopy in Adults.

Autor:	Edelson JC; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA.; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Edelson CV; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Rockey DC; Digestive Disease Research Center, Uniformed Services University of the Health Sciences, SC 20814, USA., Morales AL; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Chung KK; Digestive Disease Research Center, Uniformed Services University of the Health Sciences, SC 20814, USA., Robles MJ; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Marowske JH; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Patel AA; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Edelson SFD; Digestive Disease Research Center, Uniformed Services University of the Health Sciences, SC 20814, USA.; Department of Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Subramanian SR; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA., Gancayco JG; Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Ft. Sam Houston, TX 78824, USA.; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Jan 23; Vol. 189 (1-2), pp. 313-320.
DOI:	10.1093/milmed/usac183
Abstrakt:	Introduction: Ketamine is an effective sedative agent in a variety of settings due to its desirable properties including preservation of laryngeal reflexes and lack of cardiovascular depression. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens for patients undergoing endoscopy. Materials and Methods: We conducted a randomized controlled trial comparing ketamine to SMS for outpatient colonoscopy or esophagogastroduodenoscopy at Brooke Army Medical Center. The ketamine group received a 1-mg dose of midazolam along with ketamine, whereas the SMS group received midazolam/fentanyl. The primary outcome was patient satisfaction measured using the Patient Satisfaction in Sedation Instrument, and secondary outcomes included changes in hemodynamics, time to sedation onset and recovery, and total medication doses. Results: Thirty-three subjects were enrolled in each group. Baseline characteristics were similar. Endoscopies were performed for both diagnostic and screening purposes. Ketamine was superior in the overall sedation experience and in all analyzed categories compared to the SMS group (P = .0096). Sedation onset times and procedure times were similar among groups. The median ketamine dose was 75 mg. The median fentanyl and midazolam doses were 150 mcg and 5 mg, respectively, in SMS. Vital signs remained significantly closer to the physiological baseline in the ketamine group (P = .004). Recovery times were no different between the groups, and no adverse reactions were encountered. Conclusions: Ketamine is preferred by patients, preserves hemodynamics better than SMS, and can be safely administered by endoscopists. Data suggest that ketamine is a safe and effective sedation option for patients undergoing esophagogastroduodenoscopy or colonoscopy (clinicaltrials.gov NCT03461718). (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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