Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points
Background: Ketamine has both analgesic and sedative properties, combined with favorable hemodynamic effects, which makes it a theoretically ideal agent for bronchoscopic sedation. Studies in the adult population that demonstrate safety, efficacy, and patient/physician satisfaction are lacking. We h...
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Elsevier
2024-12-01
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| Series: | CHEST Pulmonary |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949789224000758 |
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| author | Joshua M. Boster, MD Steven T. Stoffel, DO S. Michael Goertzen, DO Melissa M. Rosas, MD Jerome C. Edelson, MD Michael J. Morris, MD Robert J. Walter, MD John C. Hunninghake, MD Edward T. McCann, MD Andrew M. Hersh, MD Jess T. Anderson, DO |
| author_facet | Joshua M. Boster, MD Steven T. Stoffel, DO S. Michael Goertzen, DO Melissa M. Rosas, MD Jerome C. Edelson, MD Michael J. Morris, MD Robert J. Walter, MD John C. Hunninghake, MD Edward T. McCann, MD Andrew M. Hersh, MD Jess T. Anderson, DO |
| author_sort | Joshua M. Boster, MD |
| collection | DOAJ |
| description | Background: Ketamine has both analgesic and sedative properties, combined with favorable hemodynamic effects, which makes it a theoretically ideal agent for bronchoscopic sedation. Studies in the adult population that demonstrate safety, efficacy, and patient/physician satisfaction are lacking. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens used for bronchoscopic sedation and may be preferred by patients and physicians. Research Question: Is ketamine an effective alternative to SMS for flexible fiberoptic bronchoscopy? Study Design and Methods: A randomized controlled trial was conducted comparing ketamine to SMS using midazolam and fentanyl for outpatient flexible fiberoptic bronchoscopy from July 2019 to March 2022. Patients who met inclusion criteria were randomized to receive either ketamine or SMS for bronchoscopic sedation. This was a single-anonymized study and the primary outcome was patient satisfaction based on the Patient Satisfaction with Sedation Instrument. Results: A total of 56 patients were enrolled with 28 randomized to each cohort. There was a significant increase in reported sedation side effects based on the Patient Satisfaction with Sedation Instrument (21.8 [SD 9.1] vs 17.0 [SD 5.6], P = .02) in the ketamine vs SMS cohorts respectively; however, global satisfaction was similar (5.4 [SD 4.6] vs 4.6 [SD 1.5], P = .38). Physician global satisfaction based on the Clinician Satisfaction with Sedation Instrument was significantly worse in the ketamine cohort (50.9 [SD 23.2] vs 35.0 [SD 10.8], P = .002), with significantly worse satisfaction scores in the sedation administration subset (26.7 [SD 12.5] vs 17.2 [SD 5.0], P ≤ .001) and secretions produced category (2.97 [SD 1.8] vs 1.93 [SD 1.6], P = .02). There were no significant differences in adverse events, and all procedures were completed successfully. Interpretation: Our results indicate that ketamine is safe in adult patients undergoing flexible fiberoptic bronchoscopy. However, the use of ketamine was associated with increased patient-reported side effects and decreased physician satisfaction. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT06181188; URL: www.clinicaltrials.gov |
| format | Article |
| id | doaj-art-4881c5675f6d45e69eb31669a4dff11e |
| institution | OA Journals |
| issn | 2949-7892 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CHEST Pulmonary |
| spelling | doaj-art-4881c5675f6d45e69eb31669a4dff11e2025-08-20T02:30:23ZengElsevierCHEST Pulmonary2949-78922024-12-012410010910.1016/j.chpulm.2024.100109Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home PointsJoshua M. Boster, MD0Steven T. Stoffel, DO1S. Michael Goertzen, DO2Melissa M. Rosas, MD3Jerome C. Edelson, MD4Michael J. Morris, MD5Robert J. Walter, MD6John C. Hunninghake, MD7Edward T. McCann, MD8Andrew M. Hersh, MD9Jess T. Anderson, DO10Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX; CORRESPONDENCE TO: Joshua M. Boster, MDPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NVGastroenterology Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXPulmonary/Critical Care Service, Montrose Regional Health, Montrose, COPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TXBackground: Ketamine has both analgesic and sedative properties, combined with favorable hemodynamic effects, which makes it a theoretically ideal agent for bronchoscopic sedation. Studies in the adult population that demonstrate safety, efficacy, and patient/physician satisfaction are lacking. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens used for bronchoscopic sedation and may be preferred by patients and physicians. Research Question: Is ketamine an effective alternative to SMS for flexible fiberoptic bronchoscopy? Study Design and Methods: A randomized controlled trial was conducted comparing ketamine to SMS using midazolam and fentanyl for outpatient flexible fiberoptic bronchoscopy from July 2019 to March 2022. Patients who met inclusion criteria were randomized to receive either ketamine or SMS for bronchoscopic sedation. This was a single-anonymized study and the primary outcome was patient satisfaction based on the Patient Satisfaction with Sedation Instrument. Results: A total of 56 patients were enrolled with 28 randomized to each cohort. There was a significant increase in reported sedation side effects based on the Patient Satisfaction with Sedation Instrument (21.8 [SD 9.1] vs 17.0 [SD 5.6], P = .02) in the ketamine vs SMS cohorts respectively; however, global satisfaction was similar (5.4 [SD 4.6] vs 4.6 [SD 1.5], P = .38). Physician global satisfaction based on the Clinician Satisfaction with Sedation Instrument was significantly worse in the ketamine cohort (50.9 [SD 23.2] vs 35.0 [SD 10.8], P = .002), with significantly worse satisfaction scores in the sedation administration subset (26.7 [SD 12.5] vs 17.2 [SD 5.0], P ≤ .001) and secretions produced category (2.97 [SD 1.8] vs 1.93 [SD 1.6], P = .02). There were no significant differences in adverse events, and all procedures were completed successfully. Interpretation: Our results indicate that ketamine is safe in adult patients undergoing flexible fiberoptic bronchoscopy. However, the use of ketamine was associated with increased patient-reported side effects and decreased physician satisfaction. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT06181188; URL: www.clinicaltrials.govhttp://www.sciencedirect.com/science/article/pii/S2949789224000758conscious sedationflexible fiberoptic bronchoscopyketaminemidazolam |
| spellingShingle | Joshua M. Boster, MD Steven T. Stoffel, DO S. Michael Goertzen, DO Melissa M. Rosas, MD Jerome C. Edelson, MD Michael J. Morris, MD Robert J. Walter, MD John C. Hunninghake, MD Edward T. McCann, MD Andrew M. Hersh, MD Jess T. Anderson, DO Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points CHEST Pulmonary conscious sedation flexible fiberoptic bronchoscopy ketamine midazolam |
| title | Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points |
| title_full | Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points |
| title_fullStr | Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points |
| title_full_unstemmed | Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points |
| title_short | Use of Ketamine for Conscious Sedation in Flexible BronchoscopyTake-home Points |
| title_sort | use of ketamine for conscious sedation in flexible bronchoscopytake home points |
| topic | conscious sedation flexible fiberoptic bronchoscopy ketamine midazolam |
| url | http://www.sciencedirect.com/science/article/pii/S2949789224000758 |
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