title: A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP.
abstract: OBJECTIVE
  Moderate to deep levels of sedation and analgesia are required for ERCP. Propofol-based sedation is simple, easy to use, and effective, but is not without cardiovascular and respiratory adverse effects. The combination of dexmedetomidine and ketamine (DK) has shown promising results for sedation in other similar scenarios. The aim of this study was to compare the efficacy and safety of a standard propofol-fentanyl (PF) regimen with a DK combination.
  
  
  METHODS
  After approval of the hospital ethics committee, 83 patients (18-75 years of age) were randomized and divided into 2 groups. Forty-two patients received a PF combination (group PF) and 41 patients received DK combination (group DK) for total intravenous anesthesia for ERCP as initial boluses followed by an infusion of PF and DK, respectively. The sedation-related adverse effects and recovery time were noted.
  
  
  RESULTS
  The mean values of the hemodynamic and respiratory parameters were in clinically acceptable ranges, but there were more episodes of hypotension (19%), bradycardia (4.7%), and decrease in oxygen saturation (Spo(2) <80% in 11.9% and Spo(2) <90% for >10 s in 42.8%) in group PF. The procedure could be completed in all of the patients but was interrupted in 6 patients in group PF because of desaturation (5) or sudden patient movement (1). The recovery time was longer in group DK than in group PF.
  
  
  CONCLUSIONS
  There were significantly fewer sedation-related adverse effects, but the recovery time was longer with DK.
authors.affiliation: Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune & Command Hospital (SC), Pune, India.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Goyal
authors.affiliation: Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune & Command Hospital (SC), Pune, India.
authors.forename: Shahbaz
authors.initials: S
authors.lastname: Hasnain
authors.affiliation: Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune & Command Hospital (SC), Pune, India.
authors.forename: Saloni
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Department of Gastroenterology, Armed Forces Medical College, Pune & Command Hospital (SC), Pune, India.
authors.forename: Sharad
authors.initials: S
authors.lastname: Shreevastava
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D001919:Bradycardia / Q000139:chemically induced; D002760:Cholangiopancreatography, Endoscopic Retrograde; D054810:Deep Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D007649:Ketamine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D007649:Ketamine; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol