Dexmedetomidine for Sedation During Upper Gastrointestinal Endoscopy

Abstract

Background:A clinical study was conducted to investigate the safety and efficacy of dexmedetomidine for sedation of patients undergoing routine upper gastrointestinal (GI) endoscopy. Methods: Forty middle-aged patients who were admitted for medical examination were randomized to receive an initial loading dose infusion of dexmedetomidine 6.0 mg/kg per h over 10 min followed by a maintenance infusion of 0.6 mg/kg per h (group A) or rapid infusion of midazolam 0.05 mg/kg (group B) as sedation for routine endoscopy. Sixty patients did not receive sedative agent (group C). Assessment included measurement of heart rate (HR), blood pressure (BP), oxygen saturation, and endoscopy duration. Results: There were no statistically significant differences among the groups in baseline characteristics.The level of sedation was similar between groups A and B, and the gag response score was significantly lower in the sedated groups than in group C. Hemodynamic stability was also demonstrated in group A during and after the endoscopic procedure. Increased systolic/diastolic BP was significantly attenuated in group A compared with group C. Interestingly, HR was significantly suppressed in group A than in groups B and C. In groups A and B, SpO2 was decreased compared with group C during and after the procedures; however, there was no significant difference between the two groups. There was no significant difference among the groups with endoscopy duration. Conclusions: For sedation during upper endoscopy, dexmedetomidine is as safe and effective as midazolam, and it significantly reduces HR and BP during and after the endoscopic procedures.

Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety

“…Of the 12 included studies, 4 were given a final JADAD score of 2 or lower [5,6,12,15] (Table 2). Although all 12 studies were randomized, not all were double-blind trials.…”

“…Two were volunteer studies in which the authors did not use blinding as this was deemed not feasible or not appropriate [5,6]. The three other studies without double-blinding were from Demiraran et al, Hashiguchi et al and Liao et al [10,12,14]. In the first study the patients and the observers were blinded, but not the physician performing the procedure.…”

“…Among ten studies (n = 737) the incidence was 0% for both groups in seven studies [7–11,15,16], while in three studies the number of adverse events was very low and the difference between groups was not statistically significant [12–14] (Table 5). …”

Study of KETODEX; Combination of Dexmedetomidine and Ketamine in Upper Gastrointestinal Scopy in Adults: Observational Study

“…Oxygen was administered routinely through nasal prongs at 4l/min Dexmedetomidine (1.5 μg/kg) iv bolus was given slowly over 5min followed by ketamine (0.5 mg/kg) before starting the endoscopic procedure . 2,6 .…”

“…Mean ARS attained in first five min was 9.18. [ Table 4] 6 he investigated the safety and efficacy of dexmedetomidine for sedation during upper gastrointestinal endoscopy. Forty middle-aged patients were randomized to receive an initial loading dose infusion of dexmedetomidine 6.0 μg/kg per h over 10 min followed by a maintenance infusion of 0.6 μg/kg per h (group A) or rapid infusion of midazolam 0.05 mg/kg (group B) as sedation for routine endoscopy.…”