Dexmedetomidine Versus Propofol Infusion During Monitored Anaesthesia Care for Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomised Double-Blind Study

• Ritika Godara

  3rd yr PG resident

  Author

• Kamlesh K. Shekhawat

  Author

• Ketki Jangid

  Author

• Amit Kumar

  Author

• PDF

Background: Monitored anaesthesia care for endoscopic retrograde cholangiopancreatography (ERCP) requires agents that balance rapid induction, procedural comfort, and cardiorespiratory safety. Dexmedetomidine and propofol differ pharmacologically in their onset, recovery, and haemodynamic profiles. This study compared their sedation efficacy and safety in adult patients undergoing ERCP.

Methods: A single-centre, hospital-based, double-blind, randomised, active-controlled prospective study was conducted at Pacific Institute of Medical Sciences, Udaipur (IEC No. STU/IEC/2024/36, dated 16.05.2024). A total of 120 adult patients undergoing elective ERCP were equally randomised to Group D (dexmedetomidine: loading 1 μg/kg over 10 minutes, maintenance 0.2–0.7 μg/kg/hour) and Group P (propofol: loading 0.5 mg/kg, maintenance 25–75 μg/kg/min). Onset time to Ramsay Sedation Scale (RSS) score 4, recovery time to RSS 1, haemodynamic and respiratory parameters, total rescue fentanyl dose, and adverse events were compared.

Results: Baseline characteristics were comparable between groups (all p > 0.05). Propofol achieved faster onset (9.18 vs 12.0 minutes; p < 0.001). Dexmedetomidine showed significantly shorter recovery (7.95 vs 22.6 minutes; p < 0.0001). Mean arterial pressure was significantly better maintained with dexmedetomidine from 15 minutes onwards (p < 0.001). Heart rate was significantly higher in the dexmedetomidine group from 45 minutes onwards. Oxygen saturation and respiratory rate were significantly better preserved with dexmedetomidine during the procedure. Rescue fentanyl requirement was higher with dexmedetomidine (118 vs 64.4 μg; p < 0.0001). No major adverse events occurred in either group.

Conclusion: Propofol offers faster onset while dexmedetomidine provides quicker recovery with superior haemodynamic and respiratory stability. Dexmedetomidine is preferred when cardiorespiratory safety is the priority; propofol when rapid induction is required. Both agents are safe for ERCP sedation without major adverse events.

Copyright (c) 2026 Ritika Godara, Kamlesh K. Shekhawat, Ketki Jangid, Amit Kumar (Author)

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