Comparative Evaluation of Propofol Fentanyl, Propofol-Midazolam and Propofol-Dexmedetomidine on Haemodynamic and Postoperative Recovery for Endoscopic Retrograde Cholangiopancreatography UC01-UC05
Dr. Vinit Kumar Srivastava,
Senior Consultant, Department of Anesthesia, Apollo Hospitals, Bilaspur, Chhattisgarh, India.
Introduction: Adequate patient sedation is mandatory for Endoscopic Retrograde Cholangiopancreatography (ERCP). Recent studies indicate that propofol and combination of midazolam or fentanyl or dexmedetomidine is superior to propofol alone in terms of haemodynamic stability, sedation efficacy and recovery parameter.
Aim: The present study compared the efficacy of propofol-fentanyl, propofol-midazolam and propofol-dexmedetomidine on haemodynamic and postoperative recovery in ERCP patients.
Materials and Methods: A total of 105 patients were randomly assigned to three groups. Group I received fentanyl 1 mcg/kg over 10 min, followed by propofol loading dose 1-2 mg/kg before procedure and maintenance 1-5 mg/kg/h throughout the procedure. Group II received midazolam 0.04 mg/kg over 10 minute, followed by the same dose of propofol and group III received dexmedetomidine 1 mcg/kg over 10 minute, followed by the same dose of propofol throughout the procedure. Heart rate, blood pressure and oxygen saturation were recorded at preoperative, after study drug, after induction, during procedure and after 5 minute of end of the procedure. Time to achieve Modified Aldrete Score of 9-10, endoscopistâ€™s satisfaction and patientsâ€™s satisfaction (according to Visual Analog Scale 0-100 mm) were also recorded. Patient characteristic data were analysed with one-way analysis of variance (ANOVA) and Chi-square test. Haemodynamic parameters were compared with ANOVA. Satisfaction score was analysed by the Kruskal-Wallis test.
Results: Demographic data of all the groups were comparable. In group III, there was no significant increase in heart rate and blood pressure values during the procedure (p>0.05), while in group I and II there was a significant change in heart rate and blood pressure at various intervals. Endoscopistâ€™s satisfaction was significantly more in group I and group III compared to group II (p<0.05), but patientsâ€™s satisfaction was similar among the groups (p>0.05).
Conclusion: Dexmedetomidine-propofol and fentanyl-propofol combination are more effective than midazolam-propofol for maintaining the haemodynamic stability during ERCP. Dexmedetomidine is most appropriate adjuvant because it reduces the pain level and the amount of propofol to be administered to the greatest extent and is not different from other agents in terms of satisfaction score and side effects.