A BIS guided comparison of propofol-fentanyl and propofol-dexmedetomidine combinations for intravenous sedation in endoscopic retrograde cholangiopancreatography (ERCP)

Abstract

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex endoscopic procedure which is sometimes quite challenging. Appropriate sedation and analgesia guarantee adequate patient participation.

Aim: To compare and evaluate the combinations of propofol-fentanyl and propofol-dexmedetomidine for intravenous sedation during ERCP using Bispectral Index (BIS).

Methods: Eighty-two patients undergoing ERCP under IV sedation were studied in two groups. Group A received fentanyl 1 mcg/kg IV, while Group B received dexmedetomidine 1 mcg/kg over 10 minutes. Both groups received an initial propofol bolus (1-2 mg/kg) followed by infusion (1-5 mg/kg/h) targeting a BIS value < 60. Additional Propofol doses were administered for BIS > 70.

Result: The onset of sedation was significantly faster in Group B (1.96 ± 0.43 min vs. 2.33 ± 0.47 min; p < 0.001). The total propofol dose required was significantly lower in Group B (initial dose: 40 ± 5.48 mg vs. 52.20 ± 4.19 mg; P < 0.001; additional dose: 83.17 ± 17.53 mg vs. 118.05 ± 18.87 mg; P < 0.001). Recovery time was shorter in Group B (9.08 ± 1.50 min vs. 11.14 ± 1.50 min; P < 0.001). Patient satisfaction was comparable between groups, but physician satisfaction was significantly higher for Group B (P < 0.05).

Conclusion:  In this study, the Dexmedetomidine-propofol combination was associated with faster onset and recovery, reduced propofol requirements, and higher physician satisfaction during ERCP compared to Fentanyl-propofol.

Keywords: Endoscopic Retrograde Cholangiopancreatography; ERCP; Bispectral Index; Dexmedetomidine; Fentanyl; Sedation; Physician Satisfaction

Citation: Kunju SG, Bhat G, Bhat MG, Sorake CJ. A BIS guided comparison of propofol-fentanyl and propofol-dexmedetomidine combinations for intravenous sedation in endoscopic retrograde cholangiopancreatography (ERCP). Anaesth. pain intensive care 2026;30(6):716-723. DOI: 10.35975/apic.v30i6.3266

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025