Dexmedetomidine versus Ketamine-Propofol for Sedation of Obese Patients Undergoing Upper Gastrointestinal Endoscopy

Abstract

Upper GI endoscopy is a highly accurate diagnostic technique which also provides an opportunity for therapeutic approach. However, it could be painful for patient and it is advised to be performed under procedural sedation. Typically, diagnostic and uncomplicated therapeutic upper endoscopy are successfully performed with moderate sedation. Deeper levels of sedation may be considered for longer and more complex procedures, including, but not limited to, ERCP and EUS. Additionally, deep sedation or general anesthesia should be considered for patients who have been difficult to manage with moderate sedation and are anticipated to be poorly responsive to sedatives. This includes patients who have had long-term use of narcotics, benzodiazepines, alcohol, or neuropsychiatric medications. The choice of sedative is based on maximizing patient comfort while minimizing risks Propofol and ketamine are commonly used as sedative agents, and each has advantages and disadvantages. Propofol is associated with hypotension, loss of airway reflexes, hypoventilation, apnea, and hypoxia but has antiemetic and amnestic properties.