title: Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for colonoscopy: a randomized, double-blind, controlled trial.
abstract: OBJECTIVE
  To evaluate the effects of low-dose ketamine on midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy.
  
  
  METHODS
  Prospective, randomized, double-blinded, placebo-controlled trial.
  
  
  METHODS
  Gastroenterology unit at a practice and clinical research center.
  
  
  METHODS
  Ninety-seven healthy American Society of Anesthesiology physical status 1 volunteers.
  
  
  METHODS
  Subjects were randomized to receive midazolam (0.02 mg/kg), fentanyl (1 μg/kg), and ketamine (0.3 mg/kg) and midazolam (0.02 mg/kg), fentanyl (1 μg/kg), and placebo (0.9% sodium chloride) in group K and group C, respectively. In both groups, incremental doses of propofol were used to maintain a Ramsay sedation score of 3 to 4.
  
  
  METHODS
  Values of heart rate, blood pressure, oxygen saturation, and respiratory rate were measured. Procedure times, recovery times, drug doses used, complications associated with the sedation, and physician and patient satisfaction were also recorded.
  
  
  RESULTS
  In group K, mean amount of propofol used and mean induction time (P < .001), the need for the use of jaw thrust maneuver and mask ventilation, and the incidence of disruptive movements were significantly lower (P < .05) and gastroenterologist satisfaction at the beginning of the procedure was significantly superior (P < .05). Mean systolic blood pressures at 4, 6, 8, and 10 minutes (P < .01); diastolic blood pressures at 4, 6, and 8 minutes (P < .05); respiratory rates at 4, 6, 8, 10, 15, 20, and 25 minutes (P < .01); and oxygen saturation at 6, 8, 10, 15, and 20 minutes (P < .05) were significantly lower in group C. Patient satisfaction scores, recovery times, and discharge times were similar. No patient in either group experienced unpleasant dreams or hallucination in the postanesthesia care unit and on the first postoperative day.
  
  
  CONCLUSIONS
  Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy resulted in more rapid and better quality of sedation, less propofol consumption, more stable hemodynamic status, and less adverse effects with similar recovery times in adult patients.
authors: Department of Anesthesiology, Baskent University Zubeyde Hanim Practice and Research Centre, Izmir, Turkey. Electronic address: tuncali.bahattin@gmail.com.
authors: Bahattin
authors: B
authors: Tuncali
authors: Department of Anesthesiology, Baskent University Zubeyde Hanim Practice and Research Centre, Izmir, Turkey.
authors: Yonca Ozvardar
authors: YO
authors: Pekcan
authors: Department of Gastroenterology, Baskent University Zubeyde Hanim Practice and Research Centre, Izmir, Turkey.
authors: Arzu
authors: A
authors: Celebi
authors: Department of Anesthesiology, Medical Faculty of Baskent University, Ankara, Turkey.
authors: Pinar
authors: P
authors: Zeyneloglu
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D003113:Colonoscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
keywords: Colonoscopy; Ketamine; Safety; Satisfaction; Sedation