Title: Study of KETODEX; Combination of Dexmedetomidine and Ketamine in Upper Gastrointestinal Scopy in Adults: Observational Study
Authors: Dr Bindya Kour Bali, Dr Alpa Patel
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.196
Abstract
Background: Aim of the study was to know clinical effects, safety and observe side effects of using the combination of dexmedetomidine and ketamine in upper gastrointestinal endoscopy in adults.
Material and Methods: A total of Sixty patients between the age group of (18 -60yrs) with American Society of Anesthesiologists class I, II or III undergoing UGIE were enrolled and an observational study was conducted over a period of 1 year. Dexmedetomidine (1.5 µg/kg) iv bolus was given slowly over 5min followed by ketamine (0.5 mg/kg) before starting the endoscopic procedure. Dexmedetomidine infusion was continued (0.5µgm/kg) and supplemental dose of ketamine was given if required .Heart rate, blood pressure and oxygen saturation, time to achieve Ramsay sedation score of 3-4 were recorded before induction, then every 5min untill recovery. The duration, ease of the procedure, time to recovery (Modified Aldrete Recovery Score) and complications if any were also recorded.
Results: UGIE could be performed with ease in 53 of the 60 cases (88.33%). No significant change in HR, Blood pressure, and Saturation (spo2) from the baseline values (p > 0.001). None of the cases experienced respiratory depression. No active airway intervention was required. Recovery profile was good.
Conclusion: Combination of dexmdetomidine and ketamine in UGIE procedure promises to be clinically effective and safe with good recovery profile .
Keywords: Dexmedetomidine, Ketamine ,Ketodex, Upper Gastrointestinal Endoscopy.
References
1. Miller D Ronald, Miller‘s Anesthesia,8th edition,2015, Elsevier Inc Publications, USA) ;30;845-58
2. Goyal R, Singh S, ShuklaR.N ,Patra A.k ,Bhargav D.V Ketodex, combination of dexmedetomidine and ketamine for upper gastrointestinal endoscopy in children. Indian J Anesth( 2013)27:461-463
3. Kim N, Yoo YC, Lee SK, Kim H, Ju HM, Min KT Comparison of the efficacy and safety of sedation between dexmedeto-midine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection World J Gastroenterol. 2015 Mar 28;21(12):3671-8
4. Y Demiraran, E Korkut, A Tamer, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study.Can J Gastroenterology 2007;21(1):25-29
5. Takimoto, K., Ueda, T., Shimamoto, F., Kojima, Y., Fujinaga, Y., Kashiwa, A., Yamauchi, H., Matsuyama, K., Toyonaga, T. and Yoshikawa, T. (2011), Sedation With Dexmedetomidine Hydrochloride During Endoscopic Submucosal Dissection Of Gastric Cancer. Digestive Endoscopy, 23: 176–181.
6. Hashiguchi K, Matsunaga H, Higuchi H, Miura S. Dexmedetomidine for sedation during upper gastrointestinal endoscopy. Dig Endosc. 2008;20:178–83.
7. Tobias JD Dexmedetomidine and ketamine: an effective alternative for procedural sedation? Pediatr Crit Care Med. 2012 Jul;13(4):423-7
8. Mester R, Easley RB, Brady KM, Chilson K, Tobias JD. Monitored anesthesia care with a combination of ketamine and dexmedetomidine during cardiac catheterization. Am J Ther 200 8;15:24-30
9. Ashraf S. Hasanina, Ahmad M. Sira Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in pediatric patients10.1016/j.egja. 2013.09.006
10. Desai PM, Umbarkar SR, Sarkar MS, Lohiya R. Conscious sedation using dexmedetomidine for percutaneous transcatheter closure of atrial septal defects: A single center experience. Ann Card Anesth 2016;19:463-7
11. Levänen J1, Mäkelä ML, Scheinin H Dexmedetomidine premedication atten-uates ketamine-induced cardiostimulatory effects and post anesthetic delirium. Anesthesiology. 1995 May;82(5):1117-25.
12. Raman V, Yacob D, Tobias JD. Dexmedetomidine-ketamine sedation during upper gastrointestinal endoscopy and biopsy in a patient with Duchenne muscular dystrophy and egg allergy. Int J Crit Illn Inj Sci 2012;2:40-3
13. K. Sudheesh, S. Harsoor Dexmedet-omidine in anesthesia practice: a wonder drug?Indian J Anesth, 55 (2011),
14. Ralph Gertler H. Cleighton Brown, Donald H. Mitchell, and Erin N. Silvius, Dexmedetomidine: a novel sedative-analgesic agent Proc (Bayle Unit Med Cent). 2001 Jan; 14(1): 13–21PMCID: PMC1291306
15. Stoeltings Pharmacology and Physiology in anesthetic Practice 5th edition Published by Wolters Kluwer 2015;5:186-95, 8:257-59,
Dr Bindya Kour Bali