A Comparative Study of Propofol-Dexmedetomidine Versus Propofol-Ketamine for the Anesthetic Management of Patients During Endoscopic Retrograde Cholangiopancreatography

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation for patient comfort and procedural success. This study compares propofol-dexmedetomidine (group DP) and propofol-ketamine (group KP) for anesthetic management during ERCP. Methods This randomized, double-blinded study enrolled 50 patients (aged 18-60 years) scheduled for ERCP at Dr. D.Y. Patil Medical College and Research Centre, Pune, Maharashtra, India. Patients were randomly allocated to group DP (n=25) or group KP (n=25). Hemodynamic parameters, propofol consumption, recovery time, post-procedural pain (visual analog scale [VAS]), sedation levels (Ramsay sedation score), and post-operative side effects were recorded and analyzed. Results Group DP showed significantly lower heart rates, systolic blood pressure, and mean arterial pressure throughout the procedure (p<0.001). Group KP had lower post-operative VAS scores only in the initial post-operative period (p<0.001 at 15 minutes) but similar Ramsay sedation scores as compared to group DP. Total propofol consumption was lower in group DP, though not statistically significant (378.9 vs 454.8 mg, p=0.08). Group DP required significantly less additional propofol bolus (7.8 vs 18 mg, p<0.001) and had shorter recovery times (7.24 vs 15.2 minutes, p<0.001). Group DP showed no incidence of post-operative nausea and vomiting (PONV) or post-operative cognitive dysfunction (POCD), while group KP had a 26.7% incidence of PONV and a 66.7% incidence of POCD. Conclusion The propofol-dexmedetomidine combination offers more stable hemodynamic control, lower propofol requirements, and quicker recovery times for ERCP anesthesia. It is recommended for patients requiring tight cardiovascular control and rapid post-procedure recovery.