A Comparison of Dexmedetomidine with Ketamine (DEXKET) and Propofol with Ketamine (KETOFOL) During Endoscopic Retrograde Cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) requires safe and effective sedation to maintain patient comfort and procedural safety. Ketamine-propofol (KetoFol) is commonly used, but risks of desaturation and delayed recovery remain. Dexmedetomidine combined with ketamine (DexKet) offers stable sedation with minimal respiratory depression. Comparative local evidence of these two combinations in ERCP patients is limited. Methods: This randomized controlled trial was conducted at the Endoscopy Department, Patel Hospital, Karachi. A total of 110 patients aged 18–60 years undergoing ERCP were randomly allocated into two groups: Group A received KetoFol, and Group B received DexKet. Oxygen saturation (SpO₂), vital signs, and Ramsay sedation scores were recorded during the procedure and recovery. Data were analyzed using appropriate statistical tests, with a p-value <0.05 considered significant. Results: Group B (DexKet) demonstrated significantly higher mean SpO₂ compared to Group A (97.5% vs. 93.2%, p<0.001) with more stable hemodynamics. At 10 minutes, deeper sedation was observed in Group B (Ramsay score 5.18 vs. 3.35), while recovery was faster at 30 minutes (2.03 vs. 5.09). Conclusion: DexKet provided superior oxygenation, more stable sedation, and quicker recovery compared to KetoFol during ERCP. This suggests DexKet as a safer and more effective alternative for procedural sedation. Further multicenter trials are recommended to confirm its wider clinical applicability.