Comparison of propofol-dexmedetomidine and propofol-ketaminecombinations in endoscopic retrograde cholangiopancreatography sedation

SUMMARY Comparison of Propofol-Dexmedetomidine and Propofol-Ketamine Combinations in Endoscopic Retrograde Cholangiopancreatography Sedation Dr. Sena FİLİZ Endoscopic retrograde cholangiopancreatography (ERCP) can be performed under minimal sedation, moderate sedation, deep sedation and general anesthesia in different centers. According to ASA guidelines, moderate or deep sedation is recommended in addition to local anesthesia during the procedure. In our study, we aimed to compare the desaturation during the procedure, hemodynamic values, use of rescue maneuvers (jaw thrust, ambu-mask, mechanical ventilation), patient and physician satisfaction, time to leave the recovery unit, and development of postoperative nausea and vomiting in patients undergoing ERCP with moderate sedation. After ethics committee approval, 80 patients were randomized into two groups: dexmedetomidine-propofol (Group DP) and ketamine-propofol (Group KP). In the DP group, 1 mcg/kg dexmedetomidine was administered within 10 min. The infusion rate was continued at 0.2-0.7 mcg/kg/hour. Patients in the CP group received 0.3 mg/kg ketamine intravenous bolus. In both groups, propofol 0.1-0.5 mg/kg loading dose was given within 3-5 min and then infusion was continued at a dose of 1.5-4.5 mg/kg/hour. All patients were administered drugs with a Quantitative Sedation Score (QSS) of 3-4 and an Integrated Pulmonary Index (IPI) of 8-10. At the end of our study, there was no difference between the groups in terms of desaturation. Bradycardia, hypotension, additional propofol use, additional fentanyl use, and duration of anesthesia were higher in the DP group, while CSS, IPI values, recovery time, patient and physician satisfaction were the same in both groups. There was no difference between the use of rescue maneuver during the procedure and post-operative nausea and vomiting. In conclusion, the combination of propofol with both dexmedetomidine and ketamine can be used in patients undergoing ERCP according to the characteristics of the patients. Keywords: ERCP, sedation, dexmedetomidine, ketamine, propofol, CSS, IPI