Dexmedetomidine as an Adjunct to Propofol for Sedationin Patients undergoing Endoscopic RetrogradeCholangiopancreatography

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) often requires moderate sedation to ensure patient comfort and procedural success. Propofol is widely used but may cause hemodynamic instability and respiratory depression at higher doses. Dexmedetomidine, an á2-adrenergic agonist with sedative and analgesic properties, may reduce these adverse effects when used as an adjunct. This study evaluated the effectiveness of dexmedetomidine in combination with propofol for moderate sedation during ERCP. Methods: This prospective study was carried out at Dhaka Medical College Hospital between March 2019 and July 2022. Thirty patients (ASA I–III) were included. Each patient received Dexmedetomidine (1 ìg/ kg over 10 minutes), followed by propofol as needed to maintain an RSS of 4. Throughout the procedure, we monitored depth of sedation, hemodynamics, oxygen saturation, pain scores, total propofol and opioid use, and recovery time. Results: The mean onset of sedation was 4.25 ± 1.45 minutes. RSS values remained stable throughout the procedure. Dexmedetomidine was associated with a moderate reduction in heart rate but without clinically significant hypotension or oxygen desaturation. The lowest SpO‚ observed was 97.5 ± 1.9%. Analgesic requirements were minimal, with F-PRS remaining low except at 25 minutes. Total propofol (75.5 ± 6.2 mg) and opioid consumption (52.5 ± 6.7 μg) were reduced. Recovery was rapid, with a mean time of 5.65 ± 1.45 minutes. Conclusion: Dexmedetomidine as an adjunct to propofol provides effective, stable moderate sedation during ERCP, offering hemodynamic stability, reduced sedative and opioid requirements, minimal respiratory compromise, and faster recovery. Its use may enhance both patient safety and procedural efficiency.

Bangladesh Society of Anaesthesiologists. 2023;36(2): 14-20