How are cognitive functions affected by different sedation methods in geriatric endoscopic retrograde cholangiopancreatography patients?

backgroundVarious sedation methods are used during endoscopic retrograde cholangiopancreatography (ERCP) procedures, which are increasingly performed in elderly patients. Our study aimed to compare the effects of propofol anesthesia with a propofol-dexmedetomidine combination on cognitive function in elderly patients undergoing ERCP.

methodsThis prospective observational study included 184 inpatients aged 65 years and older who received either propofol or a propofol-dexmedetomidine combination for sedation during ERCP. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at three time points: before the procedure and at 2 and 24 h after the procedure. The degree of frailty in patients was assessed via a frailty questionnaire. In the propofol (P) group, the propofol loading dose was 0.2–0.5 mg/kg, with a maintenance infusion dose of 0.5-4 mg/kg/h. In the propofol + dexmedetomidine (P + D) group, in addition to propofol infusion at the same doses, a loading dose of 0.5 µg/kg dexmedetomidine was administered over 10 min, followed by an infusion at a dose of 0.2–0.7 µg/kg/h.

resultsThere was no statistically significant difference between the P and P + D groups in terms of the MMSE score before the procedure (p > 0.05). However, in the P + D group, a significant improvement in the MMSE score was observed at both 2 h (z = 2.943, p = 0.003) and 24 h (z = 2.816, p = 0.005) after the procedure. The increase in MMSE scores was significantly greater in the P + D group, particularly among pre-frail patients.

conclusionOur study demonstrated that dexmedetomidine yielded more favorable results in terms of cognitive function than propofol following ERCP in geriatric patients. CLINICAL TRIALS REGISTRATION: NCT06719960. Retrospectively registered.