Dexmedetomidine and fentanyl for conscious sedation in endoscopic retrograde cholangiopancreatography

Objective To observe the safety and feasibility of dexmedetomidine and fentanyl for conscious sedation in endoscopic retrograde cholangio-pancreatography(ERCP).Methods Sixty patients of American Society of Anesthesiologists classification gradeⅠ-Ⅱ who planed to received ERCP were divided into dexmedetomidine group and propofol group,thirty cases in each group.The patients in the two groups were treated with anisodamine 10.0 mg and fentanyl 1.0 μg·kg-1 by intravenous injection before ERCP.The patients in dexmedetomidine group were treated with dexmedetomidine 0.5 μg·kg-1 by intravenous injection within 15 minutes,then the dexmedetomidine was infused continuously at the speed of 0.5-1.0 μg·kg-1·h-1 by micro-pump to the end of operation.The patients in propofol group were treated with propofol 1.0 mg·kg-1 by intravenous injection within 2 minutes,then the propofol was infused continuously at the speed of 4.0-6.0 mg·kg-1·h-1 by micro-pump to the end of operation.The blood pressure,heart rate(HR) and saturation of blood oxygen(SpO2) were recorded at the time points of before anesthesia(T0),before inserting endoscope(T1),while inserting endoscope(T2),20 minutes after inserting endoscope(T3) and 10 minutes after the end of examination(T4).The intubation process and cooperation of patients were scored;and the patients′ satisfaction for examination was evaluated next day.Results There was no significant difference in the SBP,DBP,HR and SpO2 between the two groups before anesthesia(P0.05).In dexmedetomidine group,the HR of patients at the time points of T1,T2,T3 and T4 was significantly lower than that at the time point of T0(P0.05);but there was no significant difference in the SBP and DBP among the time points of T0,T1,T2,T3 and T4(P0.05).The SBP,DBP and HR at the time points of T1,T2,T3 and T4 were significantly lower than those at the time point of T0 in propofol group(P0.05).There was no significant difference in the SpO2 among the all time points in the two groups(P0.05).The SBP at the time point of T1 and the DBP at the time points of T1,T2,T3,T4 in propofol group were significantly lower than those in dexmedetomidine group(P0.05);but there was no significant difference in the SBP at the time points of T2,T3 and T4 between the two groups(P0.05).The HR at the time points of T1,T2,T3 and T4 in propofol group was significantly higher than that in dexmedetomidine group(P0.05).The score of intubation process and cooperation of patients in dexmedetomidine group was significantly higher than that in propofol group(P0.05).There was no significant difference in the satisfactory degree of patients for examination between the two groups(P0.05).Conclusion Dexmedetomidine and fentanyl for conscious sedation in ERCP is safe and feasible,which can meet the test needs of sedation,and can obtain better cooperation of patients;but some patients with decreased HR need some intervention measures.