Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam

Abstract

Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the diff erences in effi cacy, hemodynamics, and side eff ects. Materials and Methods:Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classifi cation: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3-4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2-0.7 mcg/ kg/hr, titrated to achieve an RSS of 3-4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modifi ed Aldrete Score (MAS) reached 9-10. Patient heart rates, arterial pressure and pain were evaluated.Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p<0.05). There was no statistical diff erence in arterial pressure, RSS, MMSE or respiratory rate between the two groups. Coughing, nausea and vomiting occurred in 3 patients in Group M (12%), whereas no patient in Group D experienced these symptoms. The procedure elicited a gag response in 7 patients in Group M (28%) and in 4 patients in Group D (16%), with no signifi cant diff erence between groups (p>0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion:The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam.

Dexmedetomidine versus ketofol for moderate sedation in Endoscopic Retrograde Cholangiopancreatography (ERCP) comparative study

“…In our study there was no event of hypotension or bradycardia observed in both regimens. Patients in group D showed lower HR and MAP and these results were in accordance with previous studies [16,18]. Patients in ketofol group showed more stability in HR and MAP because propofol/ketamine combination was thought to act by antagonizing the side effect which was consistent with previous study [19].…”

“…These findings suggested that ketofol had clinical advantages over dexmedetomidine as regards controlling hemodynamic variability. In the current study there was no event of apnea or desaturation in both groups which matched with previous trials for both dexmedetomidine and ketofol [20,16]. In current study there was slight longer time to achieve RSS of 4 in group KP than group D (13.2 ± 0.5 min and 12.4 ± 1.1 min respectively) but it was still in the acceptable range and due to slow onset of action of ketamine.…”

“…The current study compared the efficacy and safety of two different regimens of moderate sedation. The dose of dexmedetomidine used in the study was similar to previous study [16]. The ketofol dose was different and new to other studies which investigated the best admixture dose.…”

Comparison of efficacy of intravenous dexmedetomidine with intravenous ketamine in allaying procedural discomfort during establishment of subarachnoid block

“…Whereas in ketamine group no patient responded to verbal command after bolus till 3min of time and majority of them (40% of the patients) regained verbal response only at 4min after bolus injection. Similarly, Kilicet al 10 found that during procedural sedation with dexmedetomidine conscious status of the patients were preserved throughout which attributed to better satisfaction. Here we attribute that maintenance of conscious status without loss of verbal response in dexmedetomidine group was very helpful during positioning the patients and also while assessing the level of subarachnoid block during the initial crucial 3mins after injection.…”

“…Patki et al have shown midazolam and propofol have equi sedative properties during spinal anaesthesia. 7 Kilic et al 10 found that dexmedetomidine at dose 1µg/kg followed by 0.5µg/kg infusion produces adequate sedation for 50 patients during ERCP with stable haemodynamics. Hence we decided to compare the sedation quality for these two drugs by giving a single bolus dose while performing subarachnoid block.…”