Effect of low dose ketamine versus dexmedetomidine on gag reflex during propofol based sedation during upper gastrointestinal endoscopy. A randomized controlled study

Objective
The aim of this study is to evaluate the effect of dexmedetomidine versus low dose ketamine on incidence of gag reflex and the total amount of propofol consumed during (UGIE) in patient sedated with propofol.
Methods
This randomized, prospective, double blind study was approved by institutional ethics committee of El-Minia university hospital and carried out in the period ranged from March 2015 to January 2016. 75 male and female patients aged from 18 to 70 years old, ASA class I–II. The patients were randomly (by computer generated table) allocated into 3 equal groups: Group(I) (propofol group), Group(II): (propofol + ketamine group), Group(III): (propofol + dexmedetomidine group). Parameters assessed was - Gag reflex, depth of sedation, total dose of propofol, oxygen saturation(spo2), hemodynamic data, time to recovery, any side effects as:- emergence delirium, and ny need for airway assistance.
Results
Gag reflex In group(I) was 32% (8 patients) versus 20% (5 patients) in group(II) and 8% (2 patients) in group(III). Patients in group(I) were significantly required higher doses of propofol when compared to group(III) and group(II), while patients in group(II) were required higher doses of propofol than group(III) with significant statistically difference. The changes of HR were comparable between the studied groups except after 2 min of induction, there were significant reduction in mean values of HR in group(I) in comparison to group(II) and group(III). As regard MAP, there were significant elevation in group(II) when compared to group(I) (at 2, 4, 6 min) and group(III) (at 2, 4, 6, 8 min, otherwise there were no significant difference. Oxygen saturation was comparable in the studied groups at all set time and there was no significant difference in their values, only 8% of patients in group(II) versus 12% in group(III) and 20% in group(I) needed jaw thrust as airway assistance. Time to recovery in group(I) was (4.84 ± 0.89 min) which was significantly longer than both group(II) (4.16 ± 1.06 min) and group(III) (4.2 ± 1.04 min).
Conclusion
Dexmedetomidine with propofol in patients undergoing UGIE was safe and effectively, can reduce the incidence of gag reflex better than ketamine when added to propofol, with less propofol consumption and better in recovery time.