Goal Directed Propofol Sedation With Magnesium Sulphate Versus Dexmedetomidine for ERCP Procedure
Status:
Completed
Trial end date:
2016-11-01
Target enrollment:
Participant gender:
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive longer endoscopic
procedure. It is performed in remote locations under a continuum of anesthetic depth, ranging
from conscious to deep sedation leading to general anesthesia.
Propofol sedation for (ERCP) procedures is the most popular current technique that has
generated controversy in the medical field. Propofol can be safely administered because of
its shorter half-life which results in a shorter recovery time than conventional sedation
(opioid and/or benzodiazepine) that makes it widely used for sedation in many
gastrointestinal procedures including ERCP. However, because of its narrow therapeutic
window, the level of conscious sedation can easily go deeper from moderately deep sedation to
near general anesthesia. Therefore, propofol as a sole agent can cause oversedation and
apnea. Depth of sedation could be estimated better when target effect concentration of
propofol is titrated by using bispectral index monitoring device(BIS).Targeting BIS within a
specific range ensures additional safety during the procedure. Scores between 60-80 have been
recommended for sedation. Propofol requirement can be reduced with addition of adjuvants (eg.
Ketamine, Magnesium sulfate and Dexmedetomidine). Most adjuncts have analgesic properties
with opioid and anesthetic sparing effects, without clinically significant respiratory
depression.
Dexmedetomidine, is a selective alpha 2 agonist; it has sedative, amnestic, and analgesic
properties. It is a useful addition to a propofol/remifentanil anesthetic combination as it
reduced their requirements intraoperatively and can help supplement analgesia
postoperatively. Its combination with propofol was proved to provide satisfactory anesthesia
for upper gastrointestinal (GI)) endoscopy in obstructive sleep apnea patients .
Magnesium can also act as an adjuvant in analgesia due to its properties as calcium channel
blocker and N-methyl-D-aspartate antagonists .It was suggested to be a near ideal intravenous
(IV) adjunct to propofol/ remifentanil based total anesthesia in gynaecology patients .
Hypothesis of this study is that Magnesium sulfate can have a propofol sparing effect during
ERCP procedures guided by BIS monitoring as efficient as dexmedetomidine but with less cost
and complications together with more patient and doctor satisfaction in addition to better
patient outcome.