Dexmedetomidine–Ketamine versus Ketamine–Propofol for Procedural Sedation in Cervical Cancer Patients Undergoing Intracavitary Brachytherapy: A Randomised Study

Background and Aims: Intracavitary brachytherapy (ICBT) is an invasive procedure requiring anaesthesia. The present study compared dexmedetomidine–ketamine (DK) versus ketamine–propofol (PK) for procedural sedation (PS) in cervical cancer patients undergoing ICBT. The primary objective of the study was to compare the time to recovery from sedation. Secondary objectives included onset of sedation, intra-operative haemodynamics and postoperative analgesia. Methods: In this double-blind, parallel-arm trial, 80 adult patients with American Society of Anesthesiologists physical status I and II, aged 20–70 years, with carcinoma cervix scheduled for elective ICBT were analysed. Group DK ( n = 40) received IV (intravenous) dexmedetomidine (0.5 µg/kg) and ketamine (1 mg/kg) and Group PK ( n = 40) received IV ketamine (1 mg/kg) and propofol (1 mg/kg). Statistical significance for continuous variables was assessed by an unpaired t -test, whereas for categorical variables, the Chi-square test was used. P < 0.05 was considered statistically significant. Results: Onset of sedation, time to recovery from sedation, time to discharge from post-anaesthesia care unit and additional doses of ketamine were comparable in both groups ( P = 0.121, 0.804 and 0.958, respectively). Patients in the Group DK had a statistically significant transient increase in blood pressure after drug administration at 1, 2, 3, 5 and 7 min as compared to the Group PK ( P < 0.05). There were no major cardiorespiratory adverse effects. Conclusion: DK is an effective alternative to PK for PS in patients undergoing ICBT with comparable onset and recovery times. The dosing regimen used provided predictable sedation with stable cardiorespiratory parameters, supporting its clinical utility as a reliable sedation protocol for day-care procedures requiring rapid recovery and early discharge.