A Study to Evaluate Efficacy and Complications of Deep Sedation Technique for Endoscopic Retrograde Cholangiopancreatography

Abstract

Background and Aims: We studied the efficacy and complications of deep sedation technique for Endoscopic retrograde cholangiopancreatography. Material and Methods: Adults patients from either gender aged 18 to 60 years (n = 60), American society of Anesthesiologists (ASA) physical status grade I and II undergoing ERCP. Patients are premedicated with glycopyrrolate 0.004 mg/kg intravenously (iv), midazolam 0.02 mg/kg/iv, fentanyl 2 μg/kg iv and sedation is induced with propofol 1 mg/kg iv with ketamine 0.5 mg/kg iv and received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by maintenance dose at 0.5 μg/kg/hr. Ramsay Sedation Scale (RSS) of 5 was considered an acceptable level for starting ERCP. Rescue Propofol 0.5 mg/kg IV was given whenever patient becomes uncomfortable or moves during the procedure. The Statistical software namely SPSS 18.0, and R environment version 3.2.2 were used for the analysis of the data. Results: Initiation of ERCP was 100% prosperous with median induction time of 10 min. Maintenance of sedation was prosperous in 100% with dexmedetomidine. After induction and giving loading dose of dexmedetomidine over 10 min, mean heart rate and blood pressure showed statistically paramount fall (P value: P<0.001) but patients were hemodynamic ally stable. We optically canvassed gagging, hypotension and bradycardia as intraprocedural adverse events in 7, 14 and 4 patients respectively. The mean time for recovery after ERCP procedure till patients achieve Modified Aldrete score (MAS) of 9 or above was 18.25±4.86 min. Conclusion: After premedication with glycopyrrolate 0.004 mg/kg/iv, midazolam 0.02 mg/kg/iv, fentanyl 2 μg/kg iv induction of deep sedation with propofol 1 mg/kg, ketamine 0.5 mg/kg, and loading dose of dexmedetomidine 1μg/kg over 10min provide good conditions for initiation of ERCP and prosperous maintenance on dexmedetomidine 0.5 μg/kg/hr and rescue doses of propofol 0.5 mg/kg without consequential adverse events and more resilient recovery.