Abstract:

Introduction: This study aimed to compare the ketamine-propofol and dexmedetomidine-propofol combinations used for endoscopic retrograde cholangiopancreatography (ERCP) performed under sedation. Primary outcomes were total propofol consumption, recovery and haemodynamic profiles of patients in each study group. Secondary outcomes were sedation-related complications and cost profiles of patients in each study group. Methods: Patients with American Society of Anaesthesiologists class I-III, aged 18-80 years, who underwent ERCP under sedation, were included in the study. Patients were randomly divided into two groups, namely the ketamine group (group KP) and the dexmedetomidine group (group DP). Group KP received 1 mg/kg ketamine plus 1 mg/kg propofol. Group DP received a loading dose of 1 μg/kg of dexmedetomidine for 10 min and a maintenance dose of 0.5 μg/kg plus 1 mg/kg of propofol. Moreover, propofol (10-20 mg) was added to keep the Ramsay Sedation scale at ≥3. Cardiopulmonary side effects, nausea, vomiting, hiccups, straining or retching were recorded in all patients. The ERCP procedure duration, as well as the awakening and recovery times, were recorded. Doses and costs of the drugs used were recorded. Patients were discharged when their Modified Alderete score was 10. Results: This study included 80 patients. The duration of ERCP in the groups KP and DP was 23.1±9.7 min and 24.4±15.2 min, respectively, and the duration of awakening was 6.0±3.2 min and 7.3±2.9 min, respectively. No statistically significant difference was noted. The recovery time was 18.6±10.6 min and 9.6±4.0 min in groups KP and DP, respectively, with a statistically significant difference noted. No statistically significant intergroup difference was noted regarding additional propofol doses; however, the total cost was $0.58±0.16 and $3.03±0.60 in groups KP and DP, respectively. Conclusion: Both ketamine-propofol and dexmedetomidine-propofol combinations provide safe and effective anaesthesia for ERCP performed under sedation. Even though the recovery time was significantly shorter in group DP, it had a significantly higher cost factor on analysis.

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