A randomized comparative study of two different concentrations of ketamine and propofol combination in upper gastrointestinal endoscopy procedures

Background Ketofol is a mixture of ketamine and propofol. It is one of the agents known to achieve procedural sedation and analgesia. Aim of the study This prospective randomized study compared the effectiveness and safety of two doses of ketofol in morbidly obese patients undergoing diagnostic upper gastrointestinal endoscopy. Methods The study included 100 adult patients, American Society of Anesthesiologists II and III. The patients were divided into two equal groups; group I in which the ketamine dose equal the propofol dose (k/p 1:1), n=50, and group II in which ketamine dose equal ¼ of the propofol dose (k/p 1:4), n=50. In separate syringes, ketamine 1mg/kg plus propofol 1mg/kg were injected intravenously in group I. In group II, patients are given ketamine 0.25 mg/kg plus propofol 1mg/kg. The bispectral index values, intraoperative hemodynamic changes, respiratory profiles, visual analogue scale pain score, and adverse events were recorded. Results No statistically significant difference between both groups regarding bispectral index values,hemodynamics, respiratory profiles, and visual analogue scale pain score. The time needed to discharge patients from the postanaesthesia care unit was prolonged in group I (39 min) compared with group II (32 min). Recovery agitation was reported in 5 patients in group I. Conclusion Both concentrations of ketamine and propofol are effective and safe in the sedation of obese patients. It is recommended to use the combination of ketamine and propofol (k/p 1:4) because this concentration is associated with a short recovery and less psychotomimetic side effects.