Effect of Diphenhydramine-Propofol versus Ketamine-Propofol in Improving Quality of Deep Sedation in Male Patients Undergoing Rigid Cystoscopy: A Comparative Study

Introduction: In this study, we aimed to compare the effects of Diphenhydramine and ketamine premedication to increase deep sedation with a low Propofol dosage in male patients for rigid cystoscopy.Methods: In this double-blinded randomized controlled trial 90 male patients were recruited whose American Society of Anesthesiologists (ASA) scored class I-II and were candidates for cystoscopy. Patients randomly sub-grouped to D received 1 mg/kg diphenhydramine and patients in the K group received 1 mg/kg ketamine intravenously and Propofol 0.5mg/kg for both groups. The primary outcome was the frequency of body movements observed at the insertion of the cystoscopic into the urethra, bladder, and cystoscopy and the grading of the patient's response when the cystoscopic enters the urethra and also during cystoscopy. The secondary outcome was the first time to add another Propofol; total perioperative Propofol doses; the time of recovery from anesthesia, incidence of adverse events, and urologist satisfaction after the procedure.Results: The median (IQR) for the ages the patients in D and K group were 35 (32,53) and 50 (35,57), respectively. The response of most patients when passing the cystoscopic through the urethra and at the same time during the cystoscopy was no response or shaking hands in both groups. The number of patients who needed to receive the first dose of Propofol in group D was slightly more than group K (84% vs 73%), (P-value=0.302). Hemodynamic changes during procedure was same in two group and the recovery time was significantly higher in the D group (18 (17,19) vs 15 (13,18) min, respectively (P-value= 0.006).Conclusion: Finally, the deep sedation of the diphenhydramine-Propofol combination was almost as good as the ketamine-Propofol combination for cystoscopy and diphenhydramine can be used as an alternative in situations where ketamine consumption is limited.