The dexmedetomidine "augmented" sedato analgesic cocktail: An effective approach for sedation in prolonged endoscopic retrograde cholangio-pancreatography

Abstract

Background and Aims:In absence of any published standard guideline for sedation or anesthesia practice for prolonged therapeutic “endoscopic retrograde cholangio-pancreatography (ERCP)”, safe and cost-effective sedation protocol is the need of the hour. Our study aims to evaluate the efficacy of a dexmedetomidine as an add-on for prolonged deep sedation for ERCP and to compare three deep sedation regimens regarding safety and efficacy.Material and Methods:Forty-five consecutively enrolled patients planned for therapeutic ERCP and assumed to have prolonged procedural duration (>50 min) were divided into three groups in a randomized assessor blinded fashion. Group 1 received propofol and midazolam, Group 2 received the sedato-analgesic cocktail containing ketamine-propofol-midazolam-pentazocine, and the Group 3 received sedate-analgesic cocktail plus dexmedetomidine infusion under monitoring of vital parameters and according to the judgment of the concerned anesthesiologist. Total propofol requirement, episodes of gagging, oxygen desaturation, changes in mean blood pressure (MBP), recovery and satisfaction score of endoscopist, anesthetist and patient were noted and analyzed statistically using one way ANOVA with Bonferroni correction and Chi-square test.Results:Mean propofol requirement, incidences of gagging and oxygen desaturation was significantly less in Group 2 and 3 compared to Group 1. MBP was more stable and recovery was faster in Group 3. Anesthetist's satisfaction was more with Group 2 and even more with Group 3.Conclusions:The sedato-analgesic cocktail was superior to the conventional propofol-midazolam regimen, dexmedetomidine as add-on increased the efficacy and safety of sedate-analgesic cocktail. It reduces propofol requirement, helps to maintain the patient in a safe and more stable level of sedation and increases satisfaction of the anesthetist.

Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)

“…The findings of our study are consistent with the findings of many previous studies [35][36][37][38][39] that compared the effects of dexmedetomidine in combination with other drugs to assess the efficacy of sedation, hemodynamic stability, recovery criteria, and satisfaction scores for patients scheduled for GIE procedures, which revealed that the combination dexmedetomidine group outperformed the other combinations in terms of sedation efficacy and safety, hemodynamic stability, recovery criteria, analgesia, and satisfaction scores. However, other studies conducted by [40][41][42][43][44] revealed inefficacy of sedation scores and the need for higher doses of adjuvant drugs to achieve the target level of sedation with less hemodynamic stability and poor recovery criteria.…”

Comparative evaluation of dexmedetomidine versus midazolam as premedication to propofol anesthesia in endoscopic retrograde cholangiopancreatography

“…Similar effect has also been observed in another studies. [161718] As dexmedetomidine is known to suppress neuronal activity and facilitate vagal activity by alpha2 receptor activation in the central nervous system; hence, it has decreased the propofol requirement in Group D.…”

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

“…Many studies have evaluated the effect of dexmedetomidine and propofol on sedation for gastrointestinal endoscopic procedures [ 6 , 7 ]. Mukhopadhyay et al found dexmedetomidine could reduce propofol requirement and provide a more stable level of sedation during ERCP procedure [ 8 ]. However, it was proved that dexmedetomidine infusion alone was not as effective as propofol on sedation quality and was associated with significantly low blood pressure and heart rate and prolonged recovery time [ 9 , 10 ].…”