ABSTRACT
INTRODUCTION: Ketamine is an effective sedative agent in a variety of settings due to its desirable properties including preservation of laryngeal reflexes and lack of cardiovascular depression. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens for patients undergoing endoscopy. MATERIALS AND METHODS: We conducted a randomized controlled trial comparing ketamine to SMS for outpatient colonoscopy or esophagogastroduodenoscopy at Brooke Army Medical Center. The ketamine group received a 1-mg dose of midazolam along with ketamine, whereas the SMS group received midazolam/fentanyl. The primary outcome was patient satisfaction measured using the Patient Satisfaction in Sedation Instrument, and secondary outcomes included changes in hemodynamics, time to sedation onset and recovery, and total medication doses. RESULTS: Thirty-three subjects were enrolled in each group. Baseline characteristics were similar. Endoscopies were performed for both diagnostic and screening purposes. Ketamine was superior in the overall sedation experience and in all analyzed categories compared to the SMS group (P = .0096). Sedation onset times and procedure times were similar among groups. The median ketamine dose was 75 mg. The median fentanyl and midazolam doses were 150 mcg and 5 mg, respectively, in SMS. Vital signs remained significantly closer to the physiological baseline in the ketamine group (P = .004). Recovery times were no different between the groups, and no adverse reactions were encountered. CONCLUSIONS: Ketamine is preferred by patients, preserves hemodynamics better than SMS, and can be safely administered by endoscopists. Data suggest that ketamine is a safe and effective sedation option for patients undergoing esophagogastroduodenoscopy or colonoscopy (clinicaltrials.gov NCT03461718).
ABSTRACT
Hepatitis B virus (HBV) and hepatitis C virus (HCV) can cause significant morbidity in military service members. Prevalences of HBV and HCV infections among military recruits accessioning into the U.S. Air Force have not previously been described. The Joint Base San Antonio-Lackland Blood Donor Center was queried for the results of HBV and HCV screening tests among all basic military trainees who donated blood between 25 November 2013 and 16 April 2016. Other active and reserve component members were excluded. The estimated prevalences of HBV and HCV infections among recruit blood donors were 0.0098% and 0.007%, respectively. This study suggests that the overall estimated prevalence of HBV and HCV infection is much lower among U.S. Air Force basic trainees, compared to other active and reserve component members and U.S. civilian populations. HBV and HCV viral infections can have a negative impact on mission readiness and individual deployment status, and have significant costs for the military. Additional studies are needed to determine cost effectiveness of screening for viral hepatitis among military populations.