Comparative evaluation of dexmedetomidine versus midazolam as premedication to propofol anesthesia in endoscopic retrograde cholangiopancreatography

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreaticobiliary diseases. It is a potentially uncomfortable procedure that needs to be performed under conscious sedation. Safe and effective sedation protocol is the need of an hour. Aims: This study aims to evaluate the requirement of propofol using midazolam and dexmedetomidine as premedication for ERCP. The degree of comfort experienced by endoscopist and the patients was also assessed. Materials and Methods: A total of sixty patients were enrolled in a randomized, assessor-blinded study in the age group of 40–80 years, American Society of Anesthesiologists physical class II–III undergoing elective ERCP procedures. They were divided into two groups of 30 each. Group D ( n = 30): Dexmedetomidine (100 μg/mL + 18 mL saline) loading dose at 1 μg/kg intravenous (IV) over 10 min followed by 0.5 μg/kg/h infusion, and Group M ( n = 30): Midazolam at 0.05 mg/kg IV bolus over 10 min followed by normal saline infusion under hemodynamic monitoring. Satisfaction scores, total propofol requirement, and complications such as gagging, restlessness, agitation, postoperative nausea and vomiting were noted and analyzed statistically. Statistical Analysis: Statistical analysis was performed using SSPS 17.0 software (SPSS Inc., 233 South Wacker Drive, Chicago, USA). The Chi-square test was applied for nonparametric data and parametric numerical data, unpaired t -test for intergroup comparison, and repeated measures ANOVA for intragroup comparison. Results were expressed as a mean ± standard deviation. Value of P < 0.05 was considered statistically significant and <0.001 as highly significant. Results: Surgeons and patients were more satisfied and comfortable along with less requirement of propofol in the dexmedetomidine group. The incidence of complications was also less in the dexmedetomidine group as compared to that of midazolam group. Conclusion: Both dexmedetomidine and midazolam can be safely administered as an anesthetic adjuvant to propofol for short procedures like ERCP's. Dexmedetomidine provided intense and better sedation quality along with lesser requirement of propofol doses. Moreover, it provided stable hemodynamic conditions and good recovery characteristics as compared to midazolam group.

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

“…This effect may be due to the higher doses of the drug, and decreased sympathetic outflow and circulating catecholamine levels [21]. Gastrointestinal endoscopy studies using dexmedetomidine and midazolam showed that the two agents do not differ from each other in terms of hypoxia, bradycardia and hypotensive effects [22]. Again, in this meta-analysis, patients who were treated with dexmedetomidine for longer procedures, such as ERCP or endoscopic mucosal resection, reported less restlessness [23].…”

“…Recovery times between the two groups are very similar. The reason for this is that we have worked with a very experienced (> 3000 cases) gastroenterologist because the duration of the procedure in our study is relatively short compared to other studies [22].…”

Effect of different doses of dexmedetomidine on the median effective concentration of propofol during gastrointestinal endoscopy: a randomized controlled trial

“…11,31,32 Recently, some researchers have studied the efficacy and safety of using dextromethorphan as an adjuvant to propofol. 16,33,34 A synergistic effect on sedation was observed in all these studies, in which the total propofol requirement in the dexmedetomidine group was significantly reduced. In this study, we demonstrated that a combination of propofol and dexmedetomidine decreased the EC 50 of propofol by TCI during gastrointestinal endoscopy.…”

“…It was reported that dexmedetomidine provided sedative and analgesic 30 effects without the risk of respiratory depression 11,31,32 . Recently, some researchers have studied the efficacy and safety of using dextromethorphan as an adjuvant to propofol 16,33,34 . A synergistic effect on sedation was observed in all these studies, in which the total propofol requirement in the dexmedetomidine group was significantly reduced.…”

Clinical usefulness of intermediate-dose dexmedetomidine (0.75 μg/kg) in flexible bronchoscopy – A prospective, randomized, double-blinded study

“…Moreover, this is achieved with a reduced occurrence of respiratory depression, in case of dexmedetomidine. [ 20 21 22 23 24 ] However, there are concerns regarding cardiovascular adverse events of dexmedetomidine, such as bradycardia and hypotension. This can prevent its more widespread use during common procedures such as flexible bronchoscopy.…”