Comparison of Propofol-Ketamine, Propofol-Fentanyl and Propofol-Lidocaine for Sedation During Upper Gastrointestinal Endoscopy: A Prospective Randomised Comparative Study
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Keywords
Gag reflex, gastrointestinal endoscopy, ketamine, lidocaine, fentanyl, propofol, sedation, NMDA receptor antagonist
Abstract
Background and Aims: Gag reflex during upper gastrointestinal endoscopy (UGIE) remains a significant procedural challenge even under propofol sedation, occurring in approximately 29% of cases. Deepening sedation to suppress gag reflex risks haemodynamic instability and respiratory depression. This study aimed to evaluate and compare the efficacy of three propofol-based drug combinations — propofol-ketamine (PK), propofol-fentanyl (PF), and propofol-lidocaine (PL) — in suppressing gag reflex, retching, and maintaining haemodynamic stability during UGIE.
Methods: This prospective, randomised, single-blind comparative study enrolled 180 ASA physical status I–II patients aged 20–60 years scheduled for diagnostic UGIE. Patients were equally randomised into three groups (n = 60 each): Group PK received propofol 0.2 mg/kg + ketamine 0.2 mg/kg IV, Group PF received propofol 0.2 mg/kg + fentanyl 1 µg/kg IV, and Group PL received propofol 0.2 mg/kg + lidocaine 1.5 mg/kg IV, each followed by a propofol infusion at 50 µg/kg/min. Primary outcome was incidence of gag reflex during endoscope insertion. Secondary outcomes included retching, haemodynamic changes, Ramsay sedation score (RSS), need for airway assistance, and emergence delirium.
Results: Gag reflex incidence was lowest in the PK group (10%) compared to PL (20%) and PF (30%). The difference between PF and PK was statistically significant (OR 3.86; 95% CI 1.36–10.57; p = 0.0064). Retching was similarly lowest in PK (11.7%) versus PF (33.3%; p = 0.0047). Hypotension was most prevalent in PL group (30%; p = 0.001) and PF group (20%), while PK exhibited the best haemodynamic profile (6.7%). Airway assistance was not required in the PK group. Emergence delirium was absent across all groups.
Conclusion: Propofol-ketamine combination provided the most effective suppression of gag reflex and retching with superior haemodynamic stability during UGIE. Propofol-lidocaine offered intermediate efficacy but carried a higher risk of hypotension. Propofol-ketamine is recommended as the preferred sedation regimen for diagnostic UGIE in ASA I–II patients.
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Chandan Sahu
Department of Anaesthesiology and Critical Care, RJN Apollo Spectra Hospital - Gwalior, Madhya Pradesh
Ruchi Singh
Department of Anaesthesia, Government institute of medical sciences, Greater Noida
