How are cognitive functions affected by different sedation methods in geriatric endoscopic retrograde cholangiopancreatography patients?

BACKGROUND: Various sedation methods are used during endoscopic retrograde cholangiopancreatography (ERCP) procedures, which are increasingly performed in elderly patients. Our study aimed to compare the effects of propofol anesthesia with a propofol-dexmedetomidine combination on cognitive function in elderly patients undergoing ERCP. METHODS: This prospective observational study included 184 inpatients aged 65 years and older who received either propofol or a propofol-dexmedetomidine combination for sedation during ERCP. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at three time points: before the procedure and at 2 and 24 h after the procedure. The degree of frailty in patients was assessed via a frailty questionnaire. In the propofol (P) group, the propofol loading dose was 0.2–0.5 mg/kg, with a maintenance infusion dose of 0.5-4 mg/kg/h. In the propofol + dexmedetomidine (P + D) group, in addition to propofol infusion at the same doses, a loading dose of 0.5 µg/kg dexmedetomidine was administered over 10 min, followed by an infusion at a dose of 0.2–0.7 µg/kg/h. RESULTS: There was no statistically significant difference between the P and P + D groups in terms of the MMSE score before the procedure (p > 0.05). However, in the P + D group, a significant improvement in the MMSE score was observed at both 2 h (z = 2.943, p = 0.003) and 24 h (z = 2.816, p = 0.005) after the procedure. The increase in MMSE scores was significantly greater in the P + D group, particularly among pre-frail patients. CONCLUSION: Our study demonstrated that dexmedetomidine yielded more favorable results in terms of cognitive function than propofol following ERCP in geriatric patients. CLINICAL TRIALS REGISTRATION: NCT06719960. Retrospectively registered.