Procedural Sedation Using a Propofol-Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical...

Area of Science:

• Anesthesiology
• Gynecological Procedures
• Pharmacology

Background:

• Loop electrosurgical excision procedure (LEEP) can cause significant pain and discomfort without adequate sedation.
• Ketamine-propofol (ketofol) admixture may improve sedation and maintain hemodynamic stability during procedures.
• This study compares ketofol ratios against propofol for procedural sedation during LEEPs.

Purpose of the Study:

• To evaluate the efficacy of two propofol-ketamine ratios versus propofol alone in minimizing patient movement during LEEP.
• To assess the impact on respiratory interventions, vital signs, sedation levels, and satisfaction.

Main Methods:

• 120 women undergoing LEEP were randomized into three groups: propofol alone (P), propofol with 0.33 mg/kg ketamine (K1), or propofol with 0.66 mg/kg ketamine (K2).
• Primary outcome: incidence of lower extremity adduction motion.
• Secondary outcomes: respiratory interventions, vital signs, sedation score, additional anesthetic use, and satisfaction.

Main Results:

• Adduction motion was significantly reduced in K1 and K2 groups compared to the P group (p<0.001).
• No significant difference in motion reduction between K1 and K2 groups.
• K2 required more jaw thrust maneuvers; K1 and K2 used less additional propofol and had higher surgeon satisfaction.

Conclusions:

• Propofol-ketamine combination is superior to propofol alone for reducing procedural interference in LEEPs.
• Increasing ketamine dosage beyond 0.33 mg/kg provided no additional benefit in movement reduction.
• Ketofol offers an effective sedation strategy for LEEP procedures.