Prospective randomized trial evaluating ketamine for advanced endoscopic procedures in difficult to sedate patients

Area of Science:

• Gastroenterology
• Anesthesiology
• Clinical Pharmacology

Background:

• Adequate patient sedation is crucial for advanced endoscopic procedures like ERCP and EUS.
• Standard sedation regimens may be insufficient for certain patient populations.

Purpose of the Study:

• To assess the efficacy and safety of ketamine as an adjunct for sedating patients with difficult-to-achieve sedation during advanced endoscopic procedures.
• To compare ketamine-based sedation with standard sedation protocols.

Main Methods:

• A prospective, randomized trial involving 175 patients undergoing ERCP or EUS who required additional sedation.
• Patients were randomized to receive either intravenous ketamine (20 mg increments) or continued standard sedation (meperidine and diazepam).

Main Results:

• The ketamine group demonstrated superior physician-rated sedation quality (P < 0.0001) and depth (P < 0.001).
• Ketamine use resulted in significantly shorter recovery times (P < 0.0001), reduced patient discomfort, and less technical difficulty.
• Sedation failure led to a higher crossover rate to ketamine from the standard sedation group (35.5% vs. 3.7%, P < 0.0001).
• Nine patients in the ketamine group experienced manageable adverse events.

Conclusions:

• Ketamine serves as an effective adjunct for conscious sedation in patients challenging to sedate.
• Ketamine offers enhanced sedation quality, depth, and quicker recovery compared to benzodiazepines and meperidine alone.
• Further research is warranted to fully explore ketamine's role in endoscopic sedation.