Use of Remifentanil or Dexmedetomidine with Ketamine for Upper Gastrointestinal Endoscopy

Abstract

We compared the effects of adding remifentanil or dexmedetomidine infusions to ketamine on the quality of anaesthesia, haemodynamics and recovery in upper gastrointestinal endoscopy (UGE). The study included 80 patients. The patients were randomised into two groups. Group R received a remifentanil infusion at a loading dose of 0.5 μg/kg/10 min, followed by 0.1 μg/kg/min of remifentanil plus 1 mg/kg of ketamine. Group D received a dexmedetomidine infusion at a loading dose of 0.5 μg/kg/10 min, followed by 0.2 μg/kg/min of dexmedetomidine plus 1 mg/kg of ketamine. In both groups, propofol (0.5-1 mg/kg) was added to the anaesthesia regimen if adequate sedation could not be achieved. The procedure commenced when a Ramsay sedation score (RSS) of 4 was achieved. After termination of anaesthesia, the modified Aldrete score (MAS) was used as the criterion for the discharge of patients from the postanaesthesia care unit. After a MAS of 9 was reached, the patient was discharged from the postanaesthesia care unit. Demographic and haemodynamic data were similar in both groups. The requirement for propofol was significantly higher in group D (p=0.002). In group R, the RSS was relatively higher in the first minute of UGE but lower at 15 min. The time to reach an RSS of 4 was significantly shorter in group R (p<0.001). Post procedural MAS values were similar in both groups (p=0.716). The time to achieve an MAS score of 9 was significantly prolonged in group D. (p=0.030). The procedural times were comparable in both groups. In conclusion; remifentanil infusion added to ketamine provides faster, more efficient sedoanalgesia and relatively more rapid recovery when compared with a dexmedetomidine infusion. © © 2014 OMU.