Effects of dexmedetomidine nasal spray combined with propofol for deep sedation in patients undergoing endoscopic retrograde cholangiopancreatography: a prospective randomized study.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) requires effective and safe deep sedation. Dexmedetomidine is a promising sedative in painless procedures. This study investigated the efficacy and safety of preoperative dexmedetomidine via nasal spray and conventional intravenous infusion for ERCP deep sedation.

METHODS

In this single-center, prospective randomized trial, 180 adult patients scheduled for ERCP were assigned to three groups: preoperative nasal spray (Group NS), intravenous pumping (Group IP), or control without dexmedetomidine (Group C). A propofol-based protocol was applied to all groups. Primary outcome was the incidence of intraoperative hypoxemia. Secondary outcomes included propofol consumption, hemodynamic stability, recovery profiles, and the incidence of other adverse events.

RESULTS

Compared to Group C, both Group NS and Group IP significantly reduced intraoperative hypoxemia (5.0% vs. 5.0% vs. 21.7%, p < 0.001), lowered propofol requirements, and improved postoperative recovery (shorter time to consciousness, lower agitation and pain scores). Group NS achieved comparable clinical benefits to Group IP but with significantly shorter anesthesia time (48.9 ± 5.2 min vs. 59.7 ± 6.4 min, p < 0.001) and higher endoscopist satisfaction (9 (9, 10) vs. 8 (7, 8), p < 0.001).

CONCLUSION

Dexmedetomidine nasal spray combined with propofol is as effective and safe as the intravenous route for ERCP deep sedation, offering the additional advantages of shorter anesthesia duration and greater procedural convenience.

CLINICAL TRIAL REGISTRATION: https://register.clinicaltrials.gov, identifier NCT07204106.