Effectiveness of Dexmedetomidine as an Adjunct Agent for Sedation during ERCP

Abstract

Objectives: To evaluate dexmedetomidine as an adjunct drug to propofol for sedation during ERCP, and its effects on perfusion index (PI) which could be used as an indicator for analgesia level.Methods: 76 patients ASA (I-III) scheduled for ERCP procedure were randomly classified to either dexmedetomidine/propofol group or propofol group. In dexmedetomidine/propofol group, sedation was induced by dexmedetomidine (0.7 µg/kg) and propofol (50 mg) followed by infusion of dexmedetomidine (0.4 µg/kg/h) and propofol (0.5-1 mg/kg/h). In propofol group, sedation was induced by propofol (50 mg) followed by propofol infusion (0.5-1 mg/kg/h). HR, SBP, DBP, RR, SPO2 and PI were continuously monitored and recorded at the time points (T0 to T8). Results:Comparing dexmedetomidine/propofol group versus propofol group; PI values showed significant increase at T2 to T7 (p˂0.001), HR values showed significant decrease at T1 to T8 (p 0.013 at T1 and 0.001 at T2 to T8), SBP values showed significant decrease at T1 to T8 (p=0.002 at T1, 0.001 at T2 to T7 and 0.004 at T8) and DBP values showed significant decrease at T4 to T6 (p value 0.008, 0.002 and 0.003 at T4.T5 and T6). RR and SPO 2 values were comparable in both groups. In dexmedetomidine/propofol group, the propofol dosage was significantly lower (p value 0.001) and the recovery time was significantly higher (p value 0.001) than that of propofol group, while the procedure time was comparable between both groups. Dexmedetomidine/propofol group showed higher incidence of bradycardia than propofol group (p value 0.035) while propofol group showed more cases with tachycardia (p value 0.016) and more cases with airway obstruction (p value 0.026).Conclusion: dexmedetomidine is a useful adjunct drug for sedation during ERCP procedure.