A comparative study of dexmedetomidine and propofol infusion during monitored anesthesia care (MAC) in endoscopic retrograde cholangiopancreatography (ERCP): a randomized controlled trial

Abstract

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.

Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study

“…We speculate that the reason may be the decreased propofol consumption during anesthesia induction. Unlike our and other research results [ 9 , 26 ], in a previous study, Muller et al showed a more significant reduction in blood pressure in patients undergoing ERCP and concluded dexmedetomidine was associated with greater hemodynamic instability [ 27 ]. Based on the biphasic effect of dexmedetomidine on blood pressure, dexmedetomidine was used only as a single loading dose to counteract the decreased blood pressure produced by propofol during anesthesia induction in our study [ 11 , 28 ].…”

Postoperative Dexmedetomidine Infusion after Microvascular Free Flap Surgery: A Case Report

“…In the earlier mentioned study by Srivastava et al, more stable mean arterial pressures were reported as compared to a propofol infusion, further supporting our use of dexmedetomidine. 22 The alpha receptors acted upon by dexmedetomidine are also located on sympathetic terminals, mediating vasoconstriction and inhibiting noradrenaline release. 23,24 Some would advocate administering dexmedetomidine before the completion of major surgical procedures, as this was associated with better hemodynamic stability in the postoperative period.…”