Comparison of Efficacy of Midazolam, Ketamine, and Combined Premedication for Endoscopic Retrograde Cholangiopancreatography

Park, Sang Heum; Kim, Sun Joo; Kim, Eun Joo; Lee, Moon Ho; Kim, Hong Soo; Chung, Il Kwun; Kim, Jae Han; Oh, Heung Seok; Han, Chan Soo

Abstract

BACKGROUND/AIMS: For prernedication of endoscopic retrograde cholangiopancreatography (ERCP), midazolam has been widely used. Combined effects of midazolam and ketamine have been reported to bring a good result in some operative cases. We evaluated the efficacy of the combined low dose administration of midazolam and ketamine as premedication for ERCP.
METHODS
Forty-three patients were divided into three groups: ketamine (K), midazolam (M), and combined group (MK). Blood pressure (BP), pulse rate (PR), electrocardiogram and O2 saturation (SaO2) were monitored. We accessed the patients level of consciousness, conditions, tolerance and satisfaction.
RESULTS
BP was significantly elevated after procedure in all groups. PR was not changed but SaO2 was slightly increased in K group. In M group, PR was significantly increased but SaO was not changed. However, all were not changed in MK group. K group was more deeply sedated than others. Significant difference was not noted among three groups in aspect of tolerance and easiness to patients during procedure with tendency to refusal for re-examination in K group. One case of PVC and two of paradoxical agitation were occurred in M group, and one of bradycardia was observed in K group.
CONCLUSIONS
Combined administration of low dose ketamine and midazolam is an effective premedication for ERCP.