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

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 ( < 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 ( < 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 ( < 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.