Safety and clinical effectiveness of propofol for endoscopic retrograde cholangiopancreatography

Knežević, Aleksandar; M, Stojsic; Gvozdenović, Ljiljana

doi:10.1016/j.ejim.2016.03.003

Cited by 1 publication

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“…In recent years, the combination of propofol and an opioid analgesic became the standard for deep sedation during ERCP, with the advantage of rapid induction, shorter time to awake, better tolerance, and satisfaction even in elderly patients [ 2 , 13 ]. However, the side effects of propofol, such as airway obstruction, hypoxia, and hypotension, are typical for the narrow therapeutic window [ 3 , 14 – 16 ]. Elderly patients are more sensitive to propofol and its respiratory adverse effects and dose-dependent hypotension [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Sun

et al. 2022

BMC Anesthesiol

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Background Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure and requires deep sedation. Deep sedation with dexmedetomidine for the respiratory drive preserved has become popular in recent years. However, the use of dexmedetomidine in elderly patients is controversial because its adverse events are more common. The objective of this study was to investigate the effectiveness of a single loading dose of dexmedetomidine combined with propofol for deep sedation of ERCP in elderly patients. Methods In this prospective randomized trial, 49 elderly patients undergoing ERCP were randomly allocated to the dexmedetomidine (DEX) or propofol (PRO) groups. The single loading dose of dexmedetomidine was set at 0.5 μg/kg at the start of anesthesia induction and loading for 10 min. The primary outcome was the cumulative dose of propofol. Secondary outcomes included time to awake, the frequency of airway interventions, and hemodynamics. Results The intraoperative cumulative dose of propofol was lower in the DEX group (111.0 ± 12.6 μg/kg/min) than the PRO group (143.7 ± 23.4 μg/kg/min) (P < 0.001). There was no statistically significant difference in the time to awake between the two groups. The incidence of artificial airway interventions and hypotension in the PRO group (36%, 60%) were significantly higher than those in the DEX group (4.2%, 16.7%) (P = 0.011, P = 0.003, respectively). In addition, the occurrence of bradycardia increased significantly in the DEX group (58.3%) compared with the PRO group (12%) (P < 0.001). Conclusions The single loading dose of dexmedetomidine combined with propofol can reduce propofol consumption and artificial airway intervention and provide better hemodynamic stability than propofol for deep sedation in elderly patients during ERCP. Trial registration www.chictr.org.cn (Registration number ChiCTR1900028069, Registration date 10/12/2019).

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