Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

Kim, Namo

doi:10.3748/wjg.v21.i12.3671

Cited by 46 publications

(28 citation statements)

References 25 publications

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“…In the present study, we observed significantly lower heart rate with dexmedetomidine during DISE compared with propofol, which could be due to decreased central noradrenaline release and sympathetic tone with the former …”

Section: Discussionsupporting

confidence: 48%

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Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

et al. 2019

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Objectives/Hypothesis: The aim of this study was to compare the effect of dexmedetomidine and propofol on airway dynamics, cardiorespiratory system, and emergence following drug-induced sleep endoscopy (DISE).Study Design: Prospective, randomized, single-blinded study. Methods: Sixty patients age 18 to 65 years in American Society of Anesthesiologists physical status groups 1 and 2 scheduled to undergo DISE were randomly allocated to either Group P (N = 30; receiving propofol infusion at 50-150 μg/kg/min) or Group D (N = 30; receiving dexmedetomidine bolus of 1 μg/kg followed by infusion at 0.5-1.0 μg/kg/hr). DISE was done at light sleep and deep sleep. Airway obstruction at tongue base was recorded as primary outcome. Airway obstruction at velum, oropharyngeal lateral wall, and epiglottis level during light and deep sedation, hemodynamic and respiratory parameters, time to attain sufficient sedation, time for emergence from sedation, and any adverse events during DISE with the two study drugs were recorded as secondary outcomes.Results: There was a greater degree of obstruction at the tongue base level (P = 0.001) and Oropharynx level (P = 0.017) in Group P compared with Group D during deep sedation. Increase in airway obstruction from light to deep sleep was seen with propofol at the oropharynx (P = 0.0185) and tongue base (P = 0.0108) levels. Two patients (6.6%) in Group D and 10 patients (33.3%) in Group P showed oxygen saturation below the minimum oxygen saturation recorded during polysomnography. Time to open eyes to call after stopping sedation was significantly less in Group P (P = 0.005).Conclusions: Dexmedetomidine shows a lesser degree of airway collapse and higher oxygen saturation levels at greater sedation depth during DISE. Propofol has a faster onset and emergence from sedation.

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Section: Discussionsupporting

confidence: 48%

“…Dexmedetomidine minimally affects the cross‐sectional area of the upper airway . The limited relaxing effect of dexmedetomidine in the upper airway with increasing doses may be the reason for not observing any change in degree of airway obstruction with dexmedetomidine in deep sedation …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

et al. 2019

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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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“…A large number of studies have also been published supporting the usefulness of sedating patients using PF alone during ESD because it achieves better outcomes, including less restlessness and quicker recovery times, and has a safety profile that is similar to conventional sedation with midazolam (MDZ) 5 6 7 . More recently, the introduction of dexmedetomidine (DEX) has attracted a considerable amount of attention for its usefulness in sedation during ESD 8 9 . However, there are currently no clearly established guidelines regarding the most effective and safe protocols for ESD or who the sedatives should be administered by.…”

Section: Introductionmentioning

confidence: 99%

Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?

et al. 2018

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Background and study aims The aim of this pilot randomized controlled trial was to evaluate and compare the satisfaction of the endoscopist along with the effectiveness and safety of sedation between sedation protocol using a combination of propofol (PF) and dexmedetomidine (DEX) (Combination group) and sedation protocol using PF alone (PF group) during gastric endoscopic submucosal dissection (ESD). Patients and methods Fifty-eight patients with gastric neoplasias scheduled for gastric ESD were enrolled and randomly assigned to the two groups. The satisfaction scores of the endoscopists and the parameters for the effectiveness and safety of sedation were evaluated by comparisons between the two groups. Results The satisfaction scores of the endoscopists, which were measured using a visual analogue scale, were significantly higher in the Combination group than in the PF group (88 vs. 69, P = 0.003). The maintenance dose of PF was lower in the Combination group than in the PF group (2 mg/kg/h vs. 5 mg/kg/h, P < 0.001), and the number of rescue PF injections was fewer in the Combination group than in the PF group (2 times vs. 6 times, P < 0.001). The incidence of bradycardia (defined as a pulse rate ≤ 45 bpm) in the Combination group was higher than that in the PF group (37.9 % vs. 10.3 %, P = 0.029). Conclusions This study suggests that gastroenterologist-directed sedation using a combination of PF and DEX during gastric ESD can enhance the satisfaction levels of endoscopists by providing stable sedation with an acceptable safety profile.

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Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

Abstract: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.

Cited by 46 publications

References 25 publications

Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

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

Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?

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