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Abstrak :
Latar Belakang: Sedasi yang efektif adalah terjaganya kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasien selama prosedur ERCP berlangsung. Propofol merupakan obat anestetik sedasi yang tidak memiliki efek analgesia dan memiliki efek depresi kardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan dapat menurunkan kebutuhan dosis propofol dalam mempertahankan kedalaman sedasi dan analgesia serta kestabilan hemodinamik dan respirasi. Penelitian ini akan membandingkan keefektifan sedasi antara campuran ketamin dan propofol (ketofol) konsentrasi 1:4, dan propofol - fentanil pada prosedur ERCP. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda pada 36 pasien yang menjalani prosedur ERCP, dengan usia 18-60 tahun, ASA I-III, BMI 18-30 kg/m 2, yang dibagi menjadi dua kelompok yaitu kelompok KF (n=18) dan kelompok PF (n=18). Kedua kelompok obat menggunakan metode infus kontinyu dengan syringe pump. Kedalaman sedasi diukur dengan menggunakan Ramsay Sedation Scale (RSS). Hasil: Dari hasil penelitian didapatkan rerata konsumsi propofol permenit kelompok campuran ketamin propofol (ketofol) ( 93,71±11,82) lebih rendah bermakna secara statistik dibandingkan kelompok propofol fentanil (141,18±19,23) (p<0.05). Jumlah median kebutuhan fentanil pada kelompok ketofol ( 0,00(0-25)) lebih rendah bermakna dibandingkan kelompok propofol fentanil (25,00 (25-50)) (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol fentanil (3,00(2-4)) dan (5,00(2-15)) lebih cepat dibandingkan kelompok ketofol (4,50(2-5)) dan (15,00 (5-20)) (p<0.05). Kejadian hipotensi pada kelompok ketofol 1,00 (5,56%) tidak berbeda bermakna secara statistik dengan kelompok propofol fentanil 3 (16,67%) (p=0,603). Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Kesimpulan: Campuran ketamin propofol (ketofol) efektif dalam menjaga kedalaman sedasi dan analgesia serta memiliki efek samping yang minimal. ...... Background: The effectiveness of sedation is the ability of the drugs to maintain the depth of sedation and analgesia as well as to control the patient movement during the ERCP procedure. Propofol is a sedation agent that has no analgesia effect and has cardiovascular and respiratory depressant effect which is dose dependent. The addition of small dose of ketamin is expected to reduce the dose required to maintain hemodinamic and respiratory stability. This study will compare the effectiveness of sedation between the used of 1:4 of ketamin propofol mixtures (ketofol) and propofol fentanyl in ERCP procedure. Methods: This study is a double blind randomised clinical trial in 36 patients who underwent ERCP procedure, aged 18-60 y.o, ASA I-III, BMI 18-30 kg / m2, which is divided into two groups: KF (n = 18) and the PF group (n = 18). Both group is using continuous syringe pump infusion. The depth of sedation was measured by using Ramsay Sedation Scale (RSS). Results: From the results, the average consumption of propofol per minute of group propofol ketamine mixtures (ketofol) (93.71 ± 11.82) was significantly lower than fentanyl propofol group (141.18 ± 19.23) (p <0.05). The median fentanyl consumption of ketofol group (0.00 (0- 25)) was significantly lower than fentanyl propofol group (25.00 (25-50)) (p <0.05). The onset and the time to recover in fentanyl propofol group (3.00 (2-4)) and (5.00 (2-15)) were faster than ketofol group (4.50 (2-5)) and (15.00 (5-20)) (p <0.05). The incidence of hypotension in group ketofol 1.00 (5.56%) was not significantly different from fentanyl propofol group 3 (16.67%) (p = 0.603). There were no desaturation events or nausea/vomiting in both groups. Conclusion: The mixture of ketamine propofol (ketofol) is effective in maintaining the depth of sedation and analgesia and has minimal side effects.

Abstrak :
Latar belakang. Endoscopic retrograde cholangio pancreatography ERCP merupakan tindakan yang dapat menimbulkan rasa tidak nyaman dan nyeri pada pasien, sehingga diperlukan obat sedasi yang adekuat. Propofol dan ketamin adalah dua obat sedasi yang sering digunakan. Penambahan ketamin pada propofol dapat melawan efek depresi pernapasan dan kardiovaskular dari propofol. Kombinasi propofol dan ketamin ketofol telah digunakan sebagai obat sedasi pada berbagai prosedur medis. Namun, evaluasi efektivitas berbagai konsentrasi ketofol terkait perubahan hemodinamik, waktu pulih, dosis, dan efek samping belum banyak diteliti. Penelitian ini bertujuan untuk membandingkan efektivitas sedasi ketofol rasio 6:1 dengan rasio 4:1 pada ERCP. Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal terhadap pasien yang menjalani ERCP di PESC RSCM pada bulan Maret-Mei 2017. Sebanyak 58 pasien diambil dan dirandomisasi menjadi dua kelompok. Kelompok K61 n=29 mendapat infus kombinasi propofol:ketamin 6:1, sedangkan kelompok K41 n=29 mendapat infus kombinasi propofol:ketamin 4:1. Kedalaman sedasi diukur menggunakan skor sedasi Ramsay. Analisis data menggunakan uji-t tidak berpasangan atau Mann-Whitney. Hasil. Rerata kebutuhan propofol antara ketofol 6:1 125,49 30,49 mcg/kg/mnt dan ketofol 4:1 121,28 28,94 mcg/kg/mnt tidak berbeda bermakna. Waktu pulih ketofol 6:1 6,55 0,5-19 mnt lebih cepat dibandingkan ketofol 4:1 11,37 4,9-20,53 mnt ......Background. Endoscopic retrograde cholangiopancreatography ERCP is a painful procedure that requires analgesic and sedative. Propofol and ketamine are common drugs that are used as sedative in ERCP. The addition of ketamine to propofol may counteract the cardiorespiratory depression caused by propofol. Ketofol, a combination of propofol and ketamine has been used as sedative in various medical procedures. However, evaluation of the effectiveness of different concentration of ketofol in procedural operation regarding changes in hemodynamic, recovery time, doses, and adverse effects was not yet studied. This study was conducted to compare the effectiveness of ketofol ratio of 6 1 with ratio of 4 1 in ERCP. Methods. This was a randomized, single blinded study in patients underwent ERCP in PESC RSCM during March May 2017. There were 58 subjects who were randomized into two groups. K61 group n 29 received an infusion of ketofol ratio of 6 1, whereas K41 group n 29 received an infusion of ketofol ratio of 4 1. Sedation level was measured with Ramsay sedation score. Data were analyzed by t test or Mann Whitney test.Results. The average requirement of propofol between K61 125,49 30,49 mcg kg min and K41 121,28 28,94 mcg kg min was not significantly different. Recovery time of K61 6,55 0,5 19 min was faster compare to K41 11,37 4,9 20,53 min . There were no desaturation and emergence delirium recorded in both groups. Hypotension was recorded in one patient in each group. Hypersalivation only reported in one patient 3.4 in K61 group, whereas in K41 group there were five patients who were reported have hypersalivation. The incidence of nausea vomiting in K61 group was 6 20.7 and in K41 group was 11 37.9 . The level of postoperative pain in both groups was not significantly different. Conclusion. Ketofol 6 1 was not more effective than ketofol 4 1 because the requirement of the drugs between both groups was not different, however ketofol 6 1 has faster recovery time and fewer adverse effects.