A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during Endoscopic retrograde cholangiopancreatography in adults


Dr.Ghassan Dakhel Ridha Alhajemi
M.B.Ch.B., Dhi Qar Al-Rifa’I hospital.
Prof. Dr. Ayad Abbas Salman
M.B.Ch. B / DA/F. I.C.M.S /CAB&IC/FIPP, Acting chairman of the Scientific Counsel of Iraqi Board Of Anesthesia and Intensive Care Baghdad-Iraq.


Background: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. This prospective clinical study investigated the safety and efficacy of midazolam -Ketamine versus propofol-fentanyl during ERCP procedures. patients and Methods: The study included 80 patients who underwent ERCP following anesthesiologist-administered sedation with fentanyl-propofol and other group midazolam-Ketamine. Procedural data, oxygen saturation, blood pressure, heart rate, recovery time, discharge times the effectiveness of sedation during the procedure was assess according to Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores. Results: Sedation related complications occurred in 13 of 40 patients in group Ketamine – midazolam and 5 of 40 patients in group fentanyl-propofol included nausea / vomiting, agitation and headache. Most events were minor and did not necessitate discontinuation of the procedure. Successful cannulation was performed in all patients. the time of recovery was significantly lower in group MK with 5.15 ± 1.3 min compared to 6.15 ± 2 in group FP, and discharge was significantly. lower in group FP with 20.35 ± 0.7 min, compared to 24.15 ± 3.4 min in group MK. this occurred due to the number of patients who had side effects in midazolam-Ketamine group was more than the other group. Conclusion: We concluded that FP, more suitable for sedation and less complications rather than MK. Although no significant complications were seen.