Publications

Background: Endoscopic retrograde cholangio-pancreatography (ERCP) is an invasive procedure and hence is
distressing for awake patients, requiring adequate level of sedation and analgesia. Recent advancements have
encouraged use of monitored anesthesia care (MAC), that allows the patient to tolerate unpleasant procedures
while maintaining cardio-respiratory function. The main aim is to compare the effect of dexmedetomidine and
propofol on the hemodynamics during ERCP, quality of sedation, recovery profile, and any side effects. A total of
100 patients were randomized by a computer-generated random number table into two groups of 30 patients
each. The group P received continuous propofol infusion at a rate of 25-75 mcg/kg/min to achieve a Ramsay
sedation scale (RSS) of 3-4 before starting the procedure. Group D received dexmedetomidine at loading dose of 1
μg/kg i.v. over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4.
Results: The present study shows significant decrease in heart rate in group D (65.27 ± 4. 3 vs.77.27 ± 9.3) with
more stable blood pressure values throughout than group P. There were episodes of transient desaturation in few
patients in group P while no patient showed any signs of respiratory depression or desaturation in group D. The
time to achieve Ramsay sedation score (RSS) 3-4 is significantly more in group D (11.4 ± 1.37 vs. 7.93 ± 1.32) with
increased tendency to use rescue drug but shows better and early recovery.
Conclusion: Dexmedetomidine is a better substitute to propofol for patients undergoing ERCP; however, use of
adjunct may be necessary to decrease the need for rescue drug.
Keywords: Dexmedetomidine, Propofol, Monitored anesthesia care (MAC), Endoscopic retrograde
cholangiopancreatography (ERCP)