Analgesie und Sedierung in der Intensivmedizin

Schaffrath, E.; Kuhlen, Ralf; Tonner, Peter H.

doi:10.1007/s00101-004-0773-2

Cited by 28 publications

(5 citation statements)

References 107 publications

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“…This is in agreement with the results of Yu et al (36) reporting that the SBP values did not present any differences after slow infusion of the drug over a 10 min time-frame. Instead, appropriate dose and transfusion velocity of dexmedetomidine may achieve favorable cardiovascular stability (37,38). However, dexmedetomidine should be used with caution in patients diagnosed with severe sinus bradycardia or heart block (39).…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus midazolam for sedation during endoscopy: A meta-analysis

Zhang

Sun

Zheng

et al. 2016

Experimental and Therapeutic Medicine

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Patients undergoing endoscopy frequently require sedation, which commonly includes the administration of midazolam or dexmedetomidine. Previous meta-analyses have mainly focused on comparing the effects of these two drugs in intensive care unit patients. In the present study, randomized controlled trials (RCTs) that compared the sedative and clinical effectiveness of these two drugs in patients undergoing endoscopy were searched in a number of databases. The meta-analysis showed that dexmedetomidine demonstrated a significantly lower rate of respiratory depression and adverse events compared with those presented upon midazolam administration. A significant difference was also observed in the sedation potency of the sedatives. The current controlled data suggest that dexmedetomidine may be an alternative to midazolam in the sedation for endoscopy. However, more high-quality and well-designed studies are required to further evaluate this conclusion.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus midazolam for sedation during endoscopy: A meta-analysis

Zhang

Sun

Zheng

et al. 2016

Experimental and Therapeutic Medicine

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“…It is important to note that we appear to have identified a source of heterogeneity in the risk of hypotension, which was reduced to 0% for all subgroups by subgroup analysis with different comparators, but there were considerable variations in results between subgroups which would be discussed below. Therefore, a complicated method of DEX administration in somewhat, including a loading dose that should be given over no less than 10 min and a maintenance dose with appropriate infusion velocity, may achieve favorable cardiovascular stability ( Schaffrath et al, 2004 ; Nishizawa et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Tang,

Huang,

Zhang

et al. 2023

Front. Pharmacol.

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Background: The sedative role of dexmedetomidine (DEX) in gastrointestinal endoscopic procedures is unclear. We performed this systematic review and meta-analysis to assess the efficacy and safety of sedation with DEX during gastrointestinal endoscopic procedures with a view to providing evidence-based references for clinical decision-making.Methods: The PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) that compared DEX with different sedatives comparators (such as propofol, midazolam, and ketamine) for sedation in a variety of adult gastrointestinal endoscopic procedures from inception to 1 July 2022. Standardized mean difference (SMD) and weighted mean difference (WMD) with 95% confidence interval (CI) or pooled risk ratios (RR) with 95% CI were used for continuous outcomes or dichotomous outcomes, respectively, and a random-effect model was selected regardless of the significance of the heterogeneity.Results: Forty studies with 2,955 patients were assessed, of which 1,333 patients were in the DEX group and 1,622 patients were in the control (without DEX) group. The results suggested that the primary outcomes of sedation level of DEX are comparable to other sedatives, with similar RSS score and patient satisfaction level, and better in some clinical outcomes, with a reduced risk of body movements or gagging (RR: 0.60; 95% CI: 0.37 to 0.97; p = 0.04; I2 = 68%), and a reduced additional requirement for other sedatives, and increased endoscopist satisfaction level (SMD: 0.41; 95% CI: 0.05 to 0.77; p = 0.03; I2 = 86%). In terms of secondary outcomes of adverse events, DEX may benefit patients in some clinical outcomes, with a reduced risk of hypoxia (RR:0.34; 95% CI: 0.20 to 0.55; p < 0.0001; I2 = 52%) and cough (RR: 0.25; 95% CI: 0.12 to 0.54; p = 0.0004; I2 = 0%), no significant difference in the risk of hypotension, while an increased risk of bradycardia (RR: 3.08; 95% CI: 2.12 to 4.48; p < 0.00001; I2 = 6%).Conclusion: This meta-analysis indicates that DEX is a safe and effective sedative agent for gastrointestinal endoscopy because of its benefits for patients in some clinical outcomes. Remarkably, DEX is comparable to midazolam and propofol in terms of sedation level. In conclusion, DEX provides an additional option in sedation for gastrointestinal endoscopic procedures.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#searchadvanced

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“…So zeigten Barrientos-Vega et al [1], dass sich die "Weaning-Zeiten" durch die Verwendung von Propofol im Vergleich zu Midazolam um etwa zwei Drittel verkür-zen ließen. Die Erklärung hierfür liegt in der ausgeprägten Kumulation von Fentanyl und Midazolam bei kontinuierlicher intravenöser Gabe [10,11,13], die so auch in der vorliegenden Untersuchung beobachtet werden konnte.…”

Section: Diskussionunclassified