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

AbstractObjectivesThe 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 methodsSixty patients aged 20–50years 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 1μg/kg over 15min then maintained by a 0.5μg/kg/h. Group KP patients received a loading dose of iv ketamine 1mg/kg over15min then maintained by 0.5mg/kg/h. Induction of anesthesia was achieved with propofol 2mg/kg, atracurium 0.5mg/kg to facilitate endotracheal intubation. Anesthesia was maintained by propofol infusion 5mg/kg/h, intermittent iv propofol boluses (0.5mg/kg) were administered if needed. MAP and HR were recorded before loading of study drugs (baseline) and recorded every 5min after beginning of loading throughout the procedure and just after intubation, then every 15min for one hour post-operative. Total propofol consumption, recovery time, VAS and postoperative complications (PONV, cognitive dysfunction, and respiratory complications) were recorded.ResultsThe 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±122.3mg) in DP group versus (304.7±142.0mg) in KP group. Postprocedural recovery time was significantly shorter in DP group (5.7±1.7min) compared with (22.2±8.2min) 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