Comparing Hemodynamic stability and recovery profiles of PROPOFOL -KETAMINE versus PROPOFOL -FENTANYL in Upper GIT Endoscopic procedures

Open Access

Abstract

Background: Gastrointestinal endoscopy requires effective sedation for comfort and procedural quality. Propofol-ketamine may provide better cardiopulmonary stability and reduce propofol requirements than propofol-fentanyl. Evidence comparing these regimens in Bangladesh remains limited. This study aimed to compare their sedation efficacy, hemodynamic and respiratory safety, adverse events, and recovery profiles. Methods & Materials: A prospective randomized study included 60 adults undergoing elective upper GI endoscopy at the National Gastroliver Institute & Hospital, Dhaka. Patients were randomized in a 1:1 ratio to PK (ketamine 0.5 mg/kg) or PF (fentanyl 1 µg/kg), followed by propofol administration. Hemodynamic and respiratory parameters, propofol requirement, time to adequate sedation, recovery and discharge times, patient and endoscopist satisfaction, and adverse events were assessed throughout the procedure. Data were analyzed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: Sixty patients were randomized equally to PK and PF groups. Baseline characteristics were comparable (p>0.05). PK showed significantly higher minimum HR, MAP, and SpO₂ than PF (p≤0.001). Total propofol use was lower with PK (84.6 ± 18.5 vs. 96.2 ± 20.7 mg, p=0.026), although time to adequate sedation, recovery, and discharge were significantly longer with PK. Patient and endoscopist satisfaction were higher with PK (p=0.031 and p=0.009). Hypotension (6.7% vs. 30.0%), bradycardia (3.3% vs. 20.0%), and desaturation (3.3% vs. 23.3%) were significantly lower with PK (p<0.05). Conclusion: Propofol-ketamine provided better hemodynamic and respiratory stability, lower propofol requirements, and higher patient and endoscopist satisfaction than propofol-fentanyl, although recovery and discharge times were slightly prolonged. These findings suggest that propofol-ketamine may be a useful alternative to propofol-fentanyl for procedural sedation during elective upper GI endoscopy.