Comparison of the Efficacy of Sedation with Dexmedetomidine plus Ketamine and Propofol plus Fentanyl in Adult Patients Undergoing ERCP Procedure

Abstract

Background: Optimal sedation for ERCP remains challenging due to painful endoscope manipulation, prolonged procedure time, and risk of respiratory depression. Dexmedetomidine–ketamine (DK) may provide stable hemodynamics and better analgesia, whereas propofol–fentanyl (PF) provides rapid onset but risks respiratory compromise.

Aim: To compare sedation efficacy, hemodynamic stability, recovery profile, and adverse events between DK and PF in adult out-patient ERCP.

Methods: A randomized controlled trial including 80 adult ERCP patients (DK: n = 40; PF: n = 40). Primary outcome: sedation efficacy (Ramsay Sedation Score, patient–endoscopist satisfaction). Secondary outcomes: hemodynamics, respiratory events, procedure time, recovery time, and complications.

Results: DK group had significantly better hemodynamic stability (p = 0.018), fewer desaturation events (5% vs. 22.5%, p = 0.019), and higher endoscopist satisfaction (p = 0.012). PF group showed faster onset and significantly shorter recovery time (17.3 ± 4.2 vs. 28.9 ± 5.1 min, p < 0.001). Sedation adequacy (RSS 5–6) was comparable (p = 0.271). Hypotension was slightly higher in PF (17.5% vs. 7.5%, p = 0.142).

Conclusion: Dexmedetomidine–ketamine provides superior hemodynamic stability and fewer respiratory events, whereas propofol–fentanyl allows faster recovery. DK appears safer for high-risk or prolonged ERCP, while PF remains useful when rapid turnover is required.