Comparison of Sedation With Ketamine-Propofol Versus Propofol-Fentanyl for Elderly Patients Undergoing Prostate Biopsy - A Retrospective Observational Study

Q: What was the study aiming to compare in elderly patients undergoing prostate biopsy?

The study compared ketamine-propofol versus propofol-fentanyl during procedural sedation for prostate biopsy in elderly patients, focusing on respiratory complications and rescue needs.

Q: How were respiratory outcomes evaluated?

Assisted ventilation was the primary outcome, and the duration of oxygen saturation (SpO2) below 90% was used as a secondary outcome.

Aug 26, 2026

Upload by Arica Lee

Procedural sedation is increasingly used for elderly patients, yet no established ideal technique exists for patients at risk of respiratory and circulatory depression. This retrospective, single-center observational study evaluated the association between respiratory complications and the sedative combinations ketamine-propofol versus fentanyl-propofol in elderly men undergoing deep sedation for prostate biopsy. Assisted ventilation was the primary outcome and time with SpO2 below 90% was assessed as a secondary outcome. Ketamine-propofol was linked to a lower need for assisted ventilation than propofol-fentanyl.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background and Aim

Methods

Results

Conclusions

Introduction

Rationale for Sedation Choice

Materials And Methods

Study Design

Study Setting

Open Access Original Article DOI: 10.7759/cureus.42650 Review began 07/15/2023 Review ended 07/25/2023 Published 07/29/2023 © Copyright 2023 Fukano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. Comparison of Sedation With Ketamine-Propofol Versus Propofol-Fentanyl for Elderly Patients Undergoing Prostate Biopsy: A Retrospective Observational Study Kentaro Fukano 1 , Yusuke Iizuka 1 , Takahiro Ueda 1 , Yu Fukuda 1 , Yuji Otsuka 1 , Masamitsu Sanui 1 1. Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN Corresponding author: Yusuke Iizuka, [zukarinn@gmail.com](zukarinn@gmail.com) Abstract Background: Procedural sedation is increasingly used for elderly patients, but there is no established ideal method for elderly patients who are prone to respiratory and circulatory depression. This study aims to investigate the association of respiratory complications and the combination of ketamine-propofol versus fentanyl-propofol in elderly patients undergoing prostate biopsy requiring deep sedation. Methods: This was a single-center, retrospective, observational study conducted from April 2020 to March 2021. We included male patients aged 65 years and older scheduled for prostate biopsy under procedural sedation. Ketamine-propofol and fentanyl-propofol were administered at the discretion of the anesthesiologist. The primary outcome was the need for assisted ventilation. The secondary outcome was the duration of oxygen saturation (SpO2) below 90% . Results: We enrolled 120 patients over 65 years, and 92 patients were included in the final analysis. The anesthesiologist administered an initial dose of ketamine and propofol of 1 : 1 to 1 :4 of 1 .0 mg kg-1 (interquartile range: 0.98 to 1. 17) or administered an initial dose of fentanyl of 0 .05 to 0.1 mg and a targetcontrolled infusion of propofol of 2 .8 μg ml-1 (interquartile range: 2.0 to 3.0) followed by additional doses atthe discretion of the anesthesiologist. Ketamine-propofol was associated with a reduced need for assisted ventilation and a shorter duration of SpO2 below 90% than propofol-fentanyl (95 . 7% vs. 4.3%, P < 0 .05; 0.64 minutes vs. 0.17 minutes, P = 0 .26) . Conclusions: Ketamine-propofol is associated with a significantly reduced need for assisted ventilation compared to propofol-fentanyl during procedural sedation and analgesia for procedures requiring deep sedation for the elderly. Categories: Anesthesiology, Urology, Geriatrics Keywords: deep sedation, elderly, fentanyl, propofol, ketamine, procedural sedation Introduction For painful or difficult procedures, procedural sedation and analgesia (PSA) allow performing the procedure while administering sedatives and analgesics to relieve the patient 's pain and anxiety [1] . It was reported that respiratory complications such as hypoxia (9 .9%) and apnea (7.2%) were most common during PSA in Japan, and these complications did not lead to serious adverse events. However, accidents such as hypoxic encephalopathy under sedation have in fact been reported and continue to occur [2] . The National Institutes of Health reported that "some of the already old countries in 2020 will continue to see rapid growth of the population 65 and older, with projected increases of higher than 10 percentage points. Examples include Japan (percent 65 and older in 2020 vs. 2050: 29.2, 40. 1) " [3] . Inevitably, procedural sedation is increasingly performed for elderly patients, but there is no ideal method of sedation defined for elderly patients prone to respiratory and circulatory depression [4,5] . A combination of propofol and fentanyl is used when a patient needs deep sedation during a painful procedure. Deep sedation results from the use

FAQs

What was the study aiming to compare in elderly patients undergoing prostate biopsy?

The study compared ketamine-propofol versus propofol-fentanyl during procedural sedation for prostate biopsy in elderly patients, focusing on respiratory complications and rescue needs.

How were respiratory outcomes evaluated?

Assisted ventilation was the primary outcome, and the duration of oxygen saturation (SpO2) below 90% was used as a secondary outcome.

What did the results show about ketamine-propofol compared with propofol-fentanyl?

Ketamine-propofol was associated with a reduced need for assisted ventilation and a shorter duration of SpO2 below 90% than propofol-fentanyl.

Aug 26, 2026

Upload by Arica Lee