title: The dexmedetomidine "augmented" sedato analgesic cocktail: An effective approach for sedation in prolonged endoscopic retrograde cholangio-pancreatography.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Anaesthesiology, Burdwan Medical College, Burdwan, India.
authors.forename: Mausumi
authors.initials: M
authors.lastname: Niyogi
authors.affiliation: Department of Gastroenterology, Kothari Medical Centre, Kolkata, India.
authors.forename: Joydip
authors.initials: J
authors.lastname: Sarkar
authors.affiliation: Department of Biochemistry, IQ City Medical College, Durgapur, West Bengal, India.
authors.forename: Basabdatta Samanta
authors.initials: BS
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Cardiology, Nilratan Sirkar Medical College, Kolkata, India.
authors.forename: Swapan Kumar
authors.initials: SK
authors.lastname: Halder
keywords: Dexmedetomidine; endoscopic retrograde cholangio-pancreatography; ketamine; propofol; sedation; sedato-analgesic cocktail