Dexmedetomidine versus Ketamine-Propofol for Sedation of Obese Patients Undergoing Upper Gastrointestinal Endoscopy

Abstract Background Gastrointestinal endoscopy is an uncomfortable and stressful procedure for most patients. Conscious sedation is a common strategy for improving patient comfort during this procedure. Benzodiazepines (gamma-aminobutyric acid (GABA) agonists) such as midazolam have been used for sedation of patients undergoing gastrointestinal endoscopy. The effective dose ranges of such agents differ considerably among patients, making it difficult to achieve stable sedation. Also obesity is a significant health problem that has assumed epidemic proportions. As a result, the number of obese patients requiring endoscopy is increasing. It is relatively unknown how safe the current practices of sedation for endoscopic procedures are in bariatric patients. Therefore, special consideration should be given to these patients Aim of the Work To compare the sedative properties and haemodynamic and respiratory effects of Dexmedetomidine and a Ketamine-Propofol combination (ketofol) in obese patients undergoing Upper GI Endoscopy. Patients and Methods This study was conducted in the endoscopy unit of Ain Shams University Hospital after obtaining approval from the Research Ethical Committee of Ain Shams University. A prospective, randomized controlled clinical trial was found to be the most suitable design in order to achieve the study objectives. Cases were divided into 2 groups using computer generated random list of numbers in sealed opaque envelopes. Results We found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or postprocedure complications. Conclusion In this study, we compared a group of 40 upper GIT endoscopy obese patients (BMI 30-40) who received procedural sedation with either Dexmedetomidine or propofolketamine combination, we found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or post procedure complications.