Propofol-dexmedetomidine versus propofol-ketamine for endoscopic retrograde cholangiopancreatography sedation.

Deep sedation during elective endoscopic retrograde cholangiopancreatography (ERCP) ensures immobility, success and stability in prone positions, yet propofol monotherapy risks hypotension, bradycardia and respiratory depression. Therefore, it is of interest to compare propofol-dexmedetomidine (PD) versus propofol-ketamine (PK) in 120 ASA I-III adults undergoing ERCP. PD provided superior hemodynamic stability (MAP fluctuation 7.9±3.1% vs. 13.8±4.7%, p=0.001), reduced propofol needs (178±46 mg vs. 241±59 mg, p=0.001) and faster recovery (11.8±3.4 vs. 17.2±5.1 min, p=0.001). Endoscopists rated PD sedation quality higher, with fewer interruptions and better patient tolerance during the procedure. PD advances ERCP sedation by offering safer, more efficient alternatives to common regimens, minimizing complications while optimizing outcomes in high-risk prone procedures.