Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP) (Comparative Study)

Abstract

ndoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the diagnosis and treatment of pancreaticobiliary pathologies and its use has increased in recent years. It is performed orally via an endoscope. It takes longer time and more complex to perform than other parallel procedures. It is extremely painful and irritating procedure when conducted without anesthesia. To ensure immobility, sufficient analgesia and the avoidance of coughing, gagging or nausea, patients should be deeply sedated or anesthetized and monitoring should be performed while undergoing ERCP procedures. Patients planned for ERCP often have additional co-morbidities that make them candidate for GA. These patients may have disturbed pharmacokinetics and greatest challenges regarding location, position, and access to the patient. Deep sedation is adequate for most procedures, but high rates of intervention to correct physiologic derangements; as hypoxemia that necessitate airway manipulation, hypotension, and termination of the procedure for critical cardio-respiratory events. GA, universally applicable, especially in very young, high ASA, high BMI, gastrointestinal bleeds, uncontrolled reflux, expected prolonged procedures, previous failed procedure, live workshop (unknown surgeon and procedure), conversion from sedation due to respiratory obstruction or procedural failure and duodenal obstruction. Co2 insufflations