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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).
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.
European Journal of Anaesthesiology
The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography
Eberl et al.
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