COMPARATIVE STUDY BETWEEN MIDAZOLAM-KETAMIN-EFENTANYL VERSUS MIDAZOLAM-KETAMINE AND MIDAZOLAM-FENTANYL WHEN USED FOR SEDATION IN DIAGNOSTIC UPPER ENDOSCOPY

Moderate sedation provides the best balance between safety and effectiveness. Midazolam and Fentanyl are the preferred benzodiazepine and opioid drugs used traditionally for endoscopic sedation. Ketamine is a useful adjunct in patients who are difficult to sedate due to better quality and depth of sedation without prolongation of the recovery time. Objective: Our primary outcome was to evaluate the efficacy of various sedation cocktails judged by the dose of propofol to supplement sedation given to the patients. Methods: The study was performed on 90 pat ients aged18 – 70 years, ASA physical status I and II scheduled to undergo elective diagnostic upper endoscopy with a goal of moderate sedation. Patients were randomly divided into 3 groups each 30 patients; Group I: Received 2mg Midazolam and 0.25mg/Kg Ketamine, Group II: Received 2mg Midazolam and 0.5ug/kg Fentanyl, Group III: Received 2mg Midazolam, 0.25mg/Kg Ketamine and 0.5ug/kg Fentanyl. Our secondary outcomes recorded were; the hemodynamic changes during the procedure, sPo2, RR and the need for airway manipulation, the discharge time, the patient and the endoscopist satisfaction and the occurrence of complications. Results: the least dose of propofol given was in group III followed by group II then group I with no statistical differences between groups I and II. As for the secondary outcomes, the heart rate as well as the mean arterial pressure were higher in group III, the respiratory rate and the oxygen saturation were higher in group III and no patient required airway manipulation. The endoscopist as well as the patient satisfaction was more in group III with no statistical differences between groups I and II. There were no statistical differences between groups as regards the discharge time. Conclusion: Moderate sedation using the combination of ketamine-Fentanyl-Midazolam provides more effective sedation and a higher level of patient and endoscopist satisfaction than those with either Midazolam -Ketamine or Midazolam -Fentanyl alone.