KETOFOL FOR OUTPATIENT TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

Objectives: This study was designed to evaluate the use of ketofol ketamine: propofol mixtures in two different ratios (1:1 and 1:2) for sedation and analgesia for outpatient transrectal ultrasound prostate biopsy. Patients Methods: A total of 105 patients scheduled for prostate biopsy were randomly allocated into 3 equal groups to receive either: propofol (Group P), ketamine + propofol in 1:1 ratio (Group KP), or ketamine + propofol in 1:2 ratio (Group KP2). Non invasive blood pressure, heart rate, and pulse oximetry were continuously monitored for all patients. Intraoperative hypotension, bradycardia, hypoxemia as well as the need to do airway support or manual ventilation were recorded. Biopsy-taking conditions were graded by the radiologist Postoperative nausea, vomiting or emergence agitation was also recorded.Measurements were done three times; biopsy time, sedation time, and discharge time.Additionally, Patient s satisfaction score, pain on propofol injection, propofol dose were recorded. Results: No reported cases of hypotension or bradycardia were detected in ketofol groups, while hypotension occurred in 48.6% and bradycardia occurred in 11.4% in propofol group. The incidence of hypoxemia and the need to perform air way support maneuvers were higher in group P. 26 procedures in group KP and 24 in group KP2 were rated excellent biopsy conditions compared to only 2 procedures in group P.Patient satisfaction did not differ among the groups. Time for home discharge was shorter in group KP2 (80.8±13) compared to groups P KP (94±14) (96±14) respectively, p 0.001. Biopsy time was shorter in ketofol groups, while sedation time was shorter in group KP2 when compared to group P. Higher propofol consumption was found in Group P compared to ketofol groups. No difference was found as regard postoperative adverse effects or pain on injection to propofol. Conclusion: Ketofol use for prostate biopsy patients provides effective sedation and analgesia with high patient safety profile, improves patient satisfaction and biopsy taking conditions. Halving ketamine concentration in ketofol 1:2 can shorten the time for home discharge.