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      Dexmedetomidine versus Ketofol Sedation for Outpatient Diagnostic Transesophageal Echocardiography: A Randomized Controlled Study

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          Moderate sedation is required for out-patient transesophageal echocardiography (TEE). Our objective was to compare the effect of Ketofol and dexmedetomidine for outpatient procedural sedation in diagnostic TEE with a hypothesis that Ketofol would be as effective as dexmedetomidine.

          Patients and Methods:

          Fifty adult patients of age group 18-60 years with atrial septal defect, rheumatic valvular heart disease undergoing diagnostic TEE in the outpatient echocardiography laboratory were randomized into two groups, group D and group KF. GROUP D: Dexmedetomidine infusion -200 μg in 20 ml normal saline. GROUP KF: Ketofol infusion: (ketamine: propofol, 1mg: 3 mg in 20 ml syringe). Loading dose of drug at 1ml/kg/hour IV till Ramsay sedation score (RSS) ≥ 3 achieved followed by maintenance infusion at 0.05 ml/kg/hour till end of procedure.


          The primary outcome - time to achieve Ramsay sedation score ≥ 3 was significantly lesser with Ketofol as compared to Dexmedetomidine 260[69] seconds vs 460 [137], (p value<0.05).


          In out-patient setting, ketofol is favourable over dexmedetomidine for sedation regimen for diagnostic TEE as lesser time is taken to achieve optimal sedation with lesser hemodynamic perturbations, post procedure complications and better cardiologist satisfaction.

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          Most cited references 36

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          Controlled sedation with alphaxalone-alphadolone.

          Alphaxalone-alphadolone (Althesin), diluted and administered as a controlled infusion, was used as a sedative for 30 patients in an intensive therapy unit. This technique allowed rapid and accurate control of the level of sedation. It had three particularly useful applications: it provided "light sleep," allowed rapid variation in the level of sedation, and enabled repeated assessment of the central nervous system.Sedation was satisfactory for 86% of the total time, and no serious complications were attributed to the use of the drug. Furthermore, though alphaxalone-alphadolone was given for periods up to 20 days there was no evidence of tachyphylaxis or delay in recovery time.
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            The post-anesthesia recovery score revisited.

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              Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.


                Author and article information

                Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
                [1 ] Department of Cardiology, PGIMER, Chandigarh, India
                Author notes
                Address for correspondence: Dr. Banashree Mandal, Department of Anaesthesia and Intensive Care, A Block, 4 th Floor, Nehru Hospital, PGIMER, Sector 12, Chandigarh - 160 012, India. E-mail: banashreemandal@
                Ann Card Anaesth
                Ann Card Anaesth
                Annals of Cardiac Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                Apr-Jun 2018
                : 21
                : 2
                : 143-150
                Copyright: © 2018 Annals of Cardiac Anaesthesia

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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