Sedation for Upper Gastrointestinal Endoscopy, whatever the Agents does it Matter

Background: Propofol is an essential agent for sedation for GI endoscopy. Opioids are administered during endoscopy to provide analgesia, suppress cough, and reduce the dose of propofol. Opioids with rapid onset and short duration are generally preferred. The most commonly used opioids in this setting is fentanyl. Ketamine also produces a dissociative state with amnesia, intense analgesia and minimal respiratory depression at sedative doses which may be administered along with propofol. The aim of study is to compare Propofol-ketamine vs propofol-fentanyl combinations for sedation during gastrointestinal endoscopy to reach a safe and satisfactory level of sedation for patients and operators with the least effective drugs as being a day case procedure with fast track criteria Methods: The study was conducted on 88 patients scheduled for diagnostic upper endoscopy. In group K; the patients in this group were injected with a combination of ketamine 0.25 mg/kg and propofol 1 mg/kg. In group F, the patients in this group were injected with a combination of Fentanyl 1ug/kg and propofol 1 mg/kg. Results: The mean procedure time in the 2 groups was (13 min ± 4.7 min in group K vs 11.76 min ± 3.8 min in group F). The volume of the drug injected was 12.3 ± 3.63 ml in group K vs 13.29 ± 4.2 ml in group F to achieve the targeted level of sedation, however the level of sedation was significantly higher in the fentofol group (RASS -5 in 20% vs. 84.4% in group K and F respectively). The level of sedation was achieved in shorter time in group K (10.8 ± 4.5 min) vs. (12.62 ± 2.92 min) in group F. The total top up dose was significantly lower in group F vs group K (6.3 ± 4.17 ml vs. 8.2 ± 3.84 ml respectively). The recovery time was significantly earlier in group F than in group K (1.83 ± 2.08 min vs. 3.5± 2.64 min). The patient's satisfaction as well as the operator satisfaction was much higher in group F than in group K. Conclusion: Fentanyl-propofol combination in the aforementioned dose is a good choice for upper GI endoscopy with a little hemodynamic change, respiratory events and earlier patients discharge.