Background and Aims
Moderate to deep levels of sedation and analgesia are required for ERCP. Propofol-based
sedation is simple, easy to use, and effective, but is not without cardiovascular
and respiratory adverse effects. The combination of dexmedetomidine and ketamine (DK)
has shown promising results for sedation in other similar scenarios. The aim of this
study was to compare the efficacy and safety of a standard propofol-fentanyl (PF)
regimen with a DK combination.
Methods
After approval of the hospital ethics committee, 83 patients (18-75 years of age)
were randomized and divided into 2 groups. Forty-two patients received a PF combination
(group PF) and 41 patients received DK combination (group DK) for total intravenous
anesthesia for ERCP as initial boluses followed by an infusion of PF and DK, respectively.
The sedation-related adverse effects and recovery time were noted.
Results
The mean values of the hemodynamic and respiratory parameters were in clinically acceptable
ranges, but there were more episodes of hypotension (19%), bradycardia (4.7%), and
decrease in oxygen saturation (Spo2 <80% in 11.9% and Spo2 <90% for >10 s in 42.8%) in group PF. The procedure could be completed in all of
the patients but was interrupted in 6 patients in group PF because of desaturation
(5) or sudden patient movement (1). The recovery time was longer in group DK than
in group PF.
Conclusion
There were significantly fewer sedation-related adverse effects, but the recovery
time was longer with DK.
Abbreviations:
DK (dexmedetomidine and ketamine), HR (heart rate), MAP (mean arterial pressure), PF (propofol and fentanyl), Spo2 (oxygen saturation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 10, 2015
Accepted:
August 6,
2015
Received:
May 14,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy.
