Propofol dexmedetomidine versus propofol ketamine for anesthesia of endoscopic retrograde cholangiopancreatography (ERCP) (A randomized comparative study)

Abstract

Objectives: The aim of this study was to compare the effects of propofol/dexmedetomidine and propofol/ketamine combinations for anesthesia in patients undergoing ERCP regarding hemodynamic changes, propofol requirements and the recovery criteria. Patient and methods: Sixty patients aged 20–50 years ASA II or III scheduled for ERCP were enrolled in this study. Patients were randomly allocated into two equal groups: dexmedetomidine/propofol (DP) group and ketamine/propofol (KP) group. DP patients received a loading dose of iv dexmedetomidine 1 μg/kg over 15 min then maintained by a 0.5 μg/kg/h. Group KP patients received a loading dose of iv ketamine 1 mg/kg over15 min then maintained by 0.5 mg/kg/h. Induction of anesthesia was achieved with propofol 2 mg/kg, atracurium 0.5 mg/kg to facilitate endotracheal intubation. Anesthesia was maintained by propofol infusion 5 mg/kg/h, intermittent iv propofol boluses (0.5 mg/kg) were administered if needed. MAP and HR were recorded before loading of study drugs (baseline) and recorded every 5 min after beginning of loading throughout the procedure and just after intubation, then every 15 min for one hour post-operative. Total propofol consumption, recovery time, VAS and postoperative complications (PONV, cognitive dysfunction, and respiratory complications) were recorded. Results: The intra-procedural HR and MAP showed high statistical significant differences between both groups throughout the procedure with lower values in DP group (p < 0.01 or <0.001). During the post-procedural period, the HR and MAP were significantly lower in DP group. Propofol consumption was comparable in both groups (268.0 ± 122.3 mg) in DP group versus (304.7 ± 142.0 mg) in KP group. Postprocedural recovery time was significantly shorter in DP group (5.7 ± 1.7 min) compared with (22.2 ± 8.2 min) KP group (p < 0.01). VAS was comparable in the two groups. PONV was 46.67% of KP group, while it was absent in DP group. Post-operative cognitive disorders showed a high statistical significant difference between both groups (p < 0.001) with no cases was reported in DP group. No respiratory complications in both groups. Conclusion: Dexmedetomidine–propofol combination as TIVA during ERCP showed better intra-and post-procedural hemodynamic stability, less PONV, less postoperative cognitive dysfunctions and shorter recovery time when compared with ketamine–propofol combination.

Keywords

• ERCP
• Dexmedetomidine
• Propofol
• Ketamine