Kolonoskopi Hastalarında Bilinçli Sedasyon ve Analjeziye Nonopioid Bir Yaklaşım; Propofol – Ketamin (Ketofol)/A Nonopioid Approach to Conscious Sedation and Analgesia in Colonoscopy Patients; Propofol - Ketamine (Ketofol)

In our study, combinations of 1: 3 Ketamine / Propofol (Group-I) and Petidin / Propofol (Group-II) applied in conscious sedation in diagnostic colonoscopy and were compared in terms of total drug dose, induction, sedation-recovery times, process satisfaction in terms of patient-endoscopist, effects on hemodynamics, respiratory parameters and other detected side effects. 60 patients assesed as ASA I-II participated in the study. In G-I, the induction time was 2.15 ± 0.38 min. and the recovery time was 22.12 ± 6.23 min. The total amount of propofol used was 67.81 ± 14.38 mg. In G-II, the induction time was 3.97 ± 1.26 minutes, and the recovery time was 12.85 ± 3.79 minutes and propofol dose was measured as 79.88 ± 17.59 mg. While there was a statistically significant difference between G / I-II in terms of total propofol dose and induction-recovery time, there was no difference in terms of colonoscopy-sedation time. In MAP, no statistically significant decrease was detected in any measurement in G-I performed in the intra-group comparison. However, the measurement in the 5th minute in G-II showed a statistically significant decrease compared to the values before the procedure. There was no difference in comparison between the groups. In HR and SpO2, there was also no statistically significant difference in the comparison between groups and within the groups. While VAS values during colonocopy in G I were 1.36 ± 1.14, the values were 2.13 ± 1.49 in G-II. Although the difference was statistically significant, both values remained below the pain limit. Although there was a statistically significant difference in RSS between G-I and II during the procedure, both groups remained within the targeted limits (RSS 3-4) before the study. The 5th minute measurements in the recovery room, RSS and OAA / S were significantly lower in G-II and the statistical difference was significant. While there was no difference in intra-group comparisons and pre-colonoscopy values in BGL, the difference between post-treatment in BG values was in an increased statistically significant manner in G-I. However, the values did not exceed hyperglycemia limits in any patient. No patient's colonoscopy was discontinuation was required due to the side effects of sedation medications and no hospitalization was essential. Although there was no statistical difference as a side effect, nausea, vomiting was more common in G-II, whereas general weakness, headache-dizziness was seen in G-I. Yet, while waking up, psychomimetic side effects such as dreaming and singing were seen only in G-I. The difference between G-I / II in terms of patient-endoscopist satisfaction was not statistically significant. In conclusion, high level of patient-physician satisfaction in diagnostic endoscopy patients suggests that ketamine is a good alternative in patients who do not want opioid use. However, we think that it may be possible to reduce ketamine dose in order to prevent psychomimetic effects. We propose options such as 10: 1, 20: 1 instead of 3: 1. However, it should be remembered that the decreased ketamine dose may not antagonize the negative effects of propofol on the respiratory system, and respiratory complications may be observed.