الفهرس 
ACKNOWLEDGMENTOnly 14 pages are availabe for public view
 |  | from | 74 |  |  |
| | | from | 74 | | |
Abstract
The question of ”why not use one drug instead of two?” remains to be answered. There is no perfect drug at present, so we will need to find the perfect combination to achieve the perfect sedation. Several factors are important in determining whether a sedative-analgesic combination is clinically acceptable. These include hemodynamic stability, effectiveness of the sedative-analgesic, the time required for surgery to start, recovery times, and the incidence of postoperative nausea and vomiting(1).
The ideal sedative-analgesic combination would provide a stable hemodynamic state, no respiratory depression, a rapid onset and recovery to baseline, and a low incidence of postoperative nausea and vomiting. Decreasing the incidence of postoperative nausea and vomiting is important because it significantly increase recovery time and is very upsetting to the patient. The ideal sedative-analgesic also will maintain a patient’s hemodynamic status to as close to the pre-sedation state as possible(1).
Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is a common procedure for diagnosis in many gastrointestinal disorders. Comfort of the patient is of great importance for ERCP to be successfully completed. A significant number of patients cannot tolerate the procedure due to lack of appropriate sedation. The aim of the sedation is to reduce the anxiety and increase the comfort of the patient and application success. Many agents such as benzodiazepines, oipoids and sedative-hypnotic drugs are used in order to increase the effectiveness of the procedure but there is no generally accepted sedation protocol for this invasive technique. Ideal sedation agent should have quick induction and recovery times with minimal side effects(2).
There is significant interest in ketofol as an agent for procedural sedation and analgesia. A combination of ketamine and propofol that can be mixed in the same syringe, or administered independently in two separate syringes. Ketofol can be administered as boluses or as a continuous infusion for longer procedures(3).
Patient and methods :
Ninety patients who were scheduled for ERCP included in this study that was carried out in Assiut university hospital and El-Raghy hospital from November 2015 to May 2017 patients were allocated randomaly into two group of 45 each:
group (KF): received ketofol (1 ketamine: 3 propofol)
group (P) : received2 mg / kg of propofol
Patients who were scheduled for ERCP were enrolled to the study after Institutional Ethics Committee approval and after written informed consent in this prospective, randomized study. Inclusion criteria included ages from 18 to 60 years, both genders and ASAII, III. ExclusionCriteriaincluded presence of liver and/or kidney failure, n History of serious adverse effects related to anaesthetics (e.g. allergic reactions), a family history of reactions to the study drugs neuropsychiatric disorders, morbid obesity, History of substance abuse or dependence and pregnancy.
Results:
There were no significant difference among groups in mean arterial blood pressure, heart rate and oxygen saturation at induction, 5 min, 10 min, 15 min, 20 min, 25 min and 30 min values.
There were no significant difference among groups in procedure time but there was high significance in total drug dosage of group(P) 283.78 ± 144.23 than group (KF) 110.94 ± 51.75 (p value<0.05).
There was significance difference in patient satisfaction between group KF (1.16 ± 0.64) and group p (1.82 ± 0.83) and in surgeon satisfaction between group KF (1.11 ± 0.49) and group p (2.13 ± 0.97)(p value<0.05).
There were significance difference in oral secretion between group KF 32 patients and group P 20 patients .There were no significance difference in hypotension, bradycardia, nausea and respiratory rate. There were 5 patients suffered from hypotension and bradycardia with group (p).
Recovery time is shorter in-group KF 9.69±1.18 more than group p 9.04±1.86 after 5 min in recovery room.
Conclusion:
Propofol-ketamine 3:1 mixture is associated with shorter recovery time, hemodynamic stability, excellent patient and surgeon satisfaction than propofol alone without important side effects in ERCP.
Recommendations:
Further studies are needed to evaluate effect of different concentration of ketamine propofol combination on hemodynamic parameters, recovery times, occurrence of adverse effects and effects on high risk patients.