Comparison of Propofol Dexmedetomidine with Propofol Ketamine for Anesthesia during Endoscopic Retrograde Cholangiopancreatography

Propofol Dexmedetomidine with Propofol Ketamine during ERCP

Abstract

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex endoscopic procedure. The combination of Propofol with dexmedetomidine or ketamine is commonly used, but the comparative efficacy and safety of these combinations remain a topic of debate. Objective: To compare the effects of propofol-dexmedetomidine versus propofol-ketamine for anesthesia in patients undergoing ERCP. Methods: This prospective cohort study was conducted at Fatima Memorial Hospital from 20 December 2025 to 20 June 2026. Consecutive sampling was used to select 150 ERCP patients, who were further allocated to two groups: propofol-dexmedetomidine (n=75) and propofol-ketamine (n=75). Baseline characteristics, hemodynamic parameters, total propofol dose, recovery time, adverse events, and satisfaction scores were measured. Data were analyzed using SPSS version 26.0, and the p-value ≤0.05 was regarded as significant. Results: Propofol-dexmedetomidine achieved greater reductions in intra-procedural heart rate and BP (all p<0.001), shorter recovery time (p<0.001), and higher endoscopist and patient satisfaction (p=0.006 and p=0.018). A higher incidence of bradycardia (p=0.005) and hypotension (p=0.016) was seen with dexmedetomidine, while more propofol was used with propofol-ketamine (p<0.001) and more excessive secretions (p=0.031) and agitation/emergence reactions (p=0.034). There was no significant difference in crude incidence of ≥1 MAE (p=0.051). Conclusions: Propofol-dexmedetomidine allowed for better procedural conditions and satisfaction, and propofol-ketamine allowed for better hemodynamic stability. Each patient should be assessed based on their risk profile and the requirements for their procedure.