Aim: Invasive diagnostic and therapeutic interventional radiological procedures can be painful and anxiety provoking. The combination of propofol and ketamine may minimize the need for supplemental opioid analgesics and has the potential to provide better sedation with less toxicity than either drug alone.
Methods: Seventy-two consenting ASA physical status I- III patients undergoing interventional radiological procedures under sedation were recruited according to a randomized, double-blind, institutional review board-approved protocol. Patients were randomized to two groups. Group 1 received propofol 0.5 mg.kg-1 + ketamine 0.5 mg.kg-1, and group 2 received propofol 0.5 mg.kg-1 + ketamine 0.25 mg.kg-1 intravenously.
Results: There were no significant differences between the two groups with respect to demographic characteristics and the duration of the interventional radiological procedure, hemodynamic data, oxygen saturation, or side-effects. However, the mean propofol dosage was higher in group 2 (33.7+/-39.3 mg) than in group 1 (15.5+/-22.3 mg), and the number of oversedated patients (sedation score >4) was higher in group 2 (19 patients) than group 1 (6 patients) (P=0.019 and P=0.001, respectively). Sixteen patients (44%) in group 1 and 21 (58%) patients in group 2 required additional propofol during the procedure. The mean recovery times were 12.1+/-1 minutes in group 1 and 13.8+/-0.8 minutes in group 2 (P>0.05).
Conclusion: In conclusion, the two different dosages of ketamine coadministered with propofol for sedation during interventional radiological procedures showed no clinically significant hemodynamic changes or side effects, and both appeared to prompt early recovery time. We recommend propofol 0.5 mg.kg-1 + ketamine 0.5 mg.kg-1 for sedation and analgesia during interventional radiological procedures, rather than propofol 0.5 mg.kg-1 + ketamine 0.25 mg.kg-1 because the former combination is associated with reduced rescue propofol requirements and therefore less oversedation.