Comparison of dexmedetomidine with on‐demand midazolam <i>versus</i> midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor

Lee, Sang Pyo; Sung, In‐Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup; Hwang, Hweung Kon; Kim, Tae‐Yop; Shim, Sang Goon

doi:10.1111/1751-2980.12254

Cited by 14 publications

(23 citation statements)

References 15 publications

(49 reference statements)

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“…According to many studies, DEX can reduce the generation of insanity and mental restlessness, and it also can maintain good mental orientation ability and discernment power when patients are completely calm. Besides, its adoption scope is also expanding [ 11 ]. With the increasing number of elderly patients, the risk of occurrence is relatively high, which will set a high standard for the way of intraoperative abdominal anesthesia and the risk generated after anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging Characteristic Evaluation of Dexmedetomidine on Neurocognitive Dysfunction in Elderly Patients with Colorectal Tumors after Laparoscopic Operation

Ding

Xia

et al. 2022

Computational and Mathematical Methods in Medicine

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In order to investigate the effects of Dexmedetomidine (DEX) on postoperative anesthesia recovery time and consciousness function in elderly patients with laparoscopic colorectal tumors, 40 patients (20 in the control group and 20 in the DEX group) were selected. The DEX group was intravenously pumped at a rate of 0.8 μg/kg/h for 10 min and then continuously pumped at a rate of 0.3 μg/kg/h until 40 min before the end of the operation. The two groups were given the same amount of normal saline, with the same way of anesthesia. The results showed that the visual analog scale (VAS) score of pain in the two groups decreased signally. Compared with the control group, the inflammatory factors tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and macrophage inflammatory protein (MIP-2) in the DEX group were remarkably decreased at T1 and T2 stages, with a considerable difference ( P < 0.05 ). One month after the auxiliary diagnosis of colorectal tumor, no clear nodular, irregular shape patches, or patchy diffuse limited points were found, which indicated that the whole tumor had been removed. In summary, DEX could improve postoperative cognitive function in elderly patients who underwent the laparoscopic radical resection of colon cancer, and its mechanism was related to the reduction of inflammatory factors. Therefore, the anesthesia intervention with DEX during the operation had a positive significance for tumor resection.

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Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging Characteristic Evaluation of Dexmedetomidine on Neurocognitive Dysfunction in Elderly Patients with Colorectal Tumors after Laparoscopic Operation

Ding

Xia

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Dexmedetomidine (DEX) is used as a sedative, and is widely used in intensive care units 6 . Several randomized controlled trials have evaluated the efficacy of DEX compared with midazolam and propofol for gastrointestinal endoscopy screening 7 , 8 . A meta-analysis shows that DEX is a safe and effective sedative agent for gastrointestinal endoscopy 9 .…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study

Kinugasa

Higashi

Miyahara

et al. 2018

Clinical and Translational Gastroenterology

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ObjectiveConscious sedation for colorectal endoscopic submucosal dissection (ESD) has not been standardized, and there are no studies of sedation for colorectal ESD.MethodsWe conducted a prospective double-blind randomized controlled trial to clarify the usefulness of DEX during colorectal ESD. In total 80 patients with colorectal ESD from April 2016 to May 2017 were assigned to the placebo group or the DEX group (40 cases each). The primary outcome was patient satisfaction (visual analogue scale: VAS). Secondary outcomes were evaluated for 13 factors, including patient pain level (VAS), endoscopist satisfaction (VAS), objective patient pain level viewed from the endoscopist’s perspective (VAS), rate of patient response, rate of side effects, etc., from the patient’s and endoscopist’s perspectives.ResultsPatient satisfaction was 8.4 and 9.1 (P = 0.018) in the placebo group and the DEX group, respectively. Secondary outcomes of patient pain level, endoscopist satisfaction, objective patient pain level from the endoscopist’s perspective for the placebo and DEX groups were 1.2 and 0.4 (P = 0.045), 8.2 and 9.3 (P < 0.001), and 1.2 and 0.5 (P = 0.002), respectively. All of these were significantly positive results (more comfortable and less pain) in the DEX group. The rate of a patient response was 100% in all cases. The side effects (hypoxia/bradycardia/hypotension) were 0%/0%/0% and 7.5%/7.5%/5% (P = 0.030). However, these rates were less than the reported side effect occurrence rate, and no additional medication was needed.ConclusionDEX enables conscious sedation, and is useful not only for patient and endoscopist satisfaction but also for pain relief. DEX is an effective sedation method for colorectal ESD.

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“…Because DEX leads to less respiratory depression than benzodiazepines, its use enables physicians to obtain an appropriate sedative effect while maintaining communication with the patient 35 . DEX can be administered intravenously during endoscopic examinations and procedures such as endoscopic submucosal dissection 36–39 . However, it is necessary to adjust the volume and manage the syringe pump during the period of administration to maintain hemodynamic control.…”

Section: Discussionmentioning

confidence: 99%

“… 35 DEX can be administered intravenously during endoscopic examinations and procedures such as endoscopic submucosal dissection. 36 , 37 , 38 , 39 However, it is necessary to adjust the volume and manage the syringe pump during the period of administration to maintain hemodynamic control. Therefore, DEX is not only expensive but also inconvenient.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

et al. 2022

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Background and Aim Radiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA. Methods We studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined. Results The median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups. Conclusion A combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.

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Comparison of dexmedetomidine with on‐demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor

Abstract: DEX with on-demand MDZ for sedation during gastric ESD is as safe as MDZ alone and the sedation effect of DEX with MDZ is superior to that of MDZ alone.

Cited by 14 publications

References 15 publications

Magnetic Resonance Imaging Characteristic Evaluation of Dexmedetomidine on Neurocognitive Dysfunction in Elderly Patients with Colorectal Tumors after Laparoscopic Operation

Magnetic Resonance Imaging Characteristic Evaluation of Dexmedetomidine on Neurocognitive Dysfunction in Elderly Patients with Colorectal Tumors after Laparoscopic Operation

Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study

Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

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