Bispectral Index (Bis) Guided Comparison Between Clinical Effects of Etomidate and Fentanyl Versus Dexmedetomidine and Fentanyl for Conscious Sedation in Ercp Procedure

Abstract

BACKGROUND Endoscopic retrograde cholangiopancreatogram (ERCP) is recently being done under conscious sedation using intravenous anaesthetic agent and fentanyl. Dexmedetomidine, a new alpha 2 agonist with analgesic and sedative effects, is now being used to induce conscious sedation.The aim of this study was to compare BIS-guided time of onset of conscious sedation and recovery profile, haemodynamic effects, physician/ patient satisfaction score and adverse events if any between patients receiving either etomidate-fentanyl or dexmedetomidine-fentanyl combination for undergoing ERCP procedure. MATERIALS AND METHODSThis is a randomised controlled trial. One hundred patients scheduled for ERCP under BIS-guided conscious sedation were randomly allocated into two equal groups to receive either etomidate-fentanyl (Group E) or dexmedetomidine-fentanyl (Group-D). After premedication with midazolam (0.05 mg/kg), glycopyrrolate (0.2 mg) and fentanyl (1 mcg/kg), etomidate or dexmedetomidine were given to the patients allocated to the respective groups to attain a BIS score of 70. Sedation was maintained throughout the procedure by continuous infusion of these drugs. The time of onset and recovery from sedation, haemodynamic effects, physicians and patient's satisfaction scores, pre-and post-operative serum cortisol and any adverse events were noted in the two groups. RESULTSThe time of onset and recovery was earlier in E group (p=0.001) Incidence of myoclonus was significantly higher in E group (p=0.022). There was higher incidence of hypertension in D group (p=0.012). Physician and patient satisfaction were comparable in both the groups. There was no difference in pre-op and 12-hour post-op serum cortisol in either group. CONCLUSIONBIS-guided etomidate-fentanyl for ERCP resulted in earlier onset and recovery from sedation with stable haemodynamics compared with dexmedetomidine-fentanyl.