There is paucity of data concerning the most suitable sedation treatment for endoscopic retrograde cholangiopancreatography (ERCP), one of the most complicated gastrointestinal endoscopic procedures.  A comparison favoring low-dose esketamine over propofol TCI (Marsh model) and recurrent bolus alfentanil in terms of propfol requirement has been portrayed in this study of ASA PS I and II patients.

This randomized controlled multicentre study aimed to evaluate the efficacy of esketamine in comparison with alfentanil as an adjunct to propofol target-controlled infusion (TCI) for deep sedation during ambulant endoscopic retrograde cholangiopancreatography (ERCP).

The adults as per the American Society of Anesthesiologists Physical Status (ASA PS) I to III patients planned to undergo ERCP were included.These patients were arbitrarily allocated to receive sedation for an ERCP with propofol TCI and alfentanil ie. group A or with propofol TCI and esketamine i.e group E. The efficacy of the sedation regimen defined as the total dose of propofol – as a surrogate parameter – needed to perform ERCP in a suitable manner for endoscopist and patients was considered as a primary outcome. Time of recovery, the patients’ and endoscopists’ satisfaction with sedation, side effects (for instance psychotomimetic effects, nausea and vomiting) and the number of respiratory and cardiovascular adverse events were considered as secondary outcomes.

As per the analysis of data from 162 patients, total dose of propofol required was significantly lower in group E (n=83) (8.3 mg kg−1 h−1) as compared to in group A (n=79) (10.5 mg kg−1 h−1). No major differences in time of recovery, satisfaction of patients’ and endoscopists’, side effects, psychotomimetic effects and the number of sedation-related adverse events were observed. 

As compared to alfentanil,  low doses of esketamine decreases the total amount of propofol required for sedation during ERCP without affecting recovery time, satisfaction of patients and endoscopists, side effects and respiratory or cardiovascular adverse events.