Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure and requires deep sedation. Deep sedation with dexmedetomidine for the respiratory drive preserved has become popular in recent years. However, the use of dexmedetomidine in elderly patients is controversial because its adverse events are more common. The objective of this study was to investigate the effectiveness of a single loading dose of dexmedetomidine combined with propofol for deep sedation of ERCP in elderly patients. Methods In this prospective randomized trial, 49 elderly patients undergoing ERCP were randomly allocated to the dexmedetomidine (DEX) or propofol (PRO) groups. The single loading dose of dexmedetomidine was set at 0.5 μg/kg at the start of anesthesia induction and loading for 10 min. The primary outcome was the cumulative dose of propofol. Secondary outcomes included time to awake, the frequency of airway interventions, and hemodynamics. Results The intraoperative cumulative dose of propofol was lower in the DEX group (111.0 ± 12.6 μg/kg/min) than the PRO group (143.7 ± 23.4 μg/kg/min) (P < 0.001). There was no statistically significant difference in the time to awake between the two groups. The incidence of artificial airway interventions and hypotension in the PRO group (36%, 60%) were significantly higher than those in the DEX group (4.2%, 16.7%) (P = 0.011, P = 0.003, respectively). In addition, the occurrence of bradycardia increased significantly in the DEX group (58.3%) compared with the PRO group (12%) (P < 0.001). Conclusions The single loading dose of dexmedetomidine combined with propofol can reduce propofol consumption and artificial airway intervention and provide better hemodynamic stability than propofol for deep sedation in elderly patients during ERCP. Trial registration www.chictr.org.cn (Registration number ChiCTR1900028069, Registration date 10/12/2019).

Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

“…Nineteen studies ( Jalowiecki et al, 2005a ; Takimoto et al, 2011 ; Vázquez-Reta et al, 2011 ; Mazanikov et al, 2013 ; Lee et al, 2014 ; Samson et al, 2014 ; Lee et al, 2015 ; Goyal et al, 2016 ; Karanth et al, 2018 ; Kinugasa et al, 2018 ; Nonaka et al, 2018 ; Srivastava et al, 2018 ; Yin et al, 2019 ; Ahmed et al, 2020 ; Koruk et al, 2020 ; Algharabawy et al, 2021 ; Ashikari et al, 2021 ; Aminnejad et al, 2022 ; Chen et al, 2022 ) recorded the risk of hypotension, with 787 patients in the control group vs. 776 patients in the DEX group. There was no significant difference in risk of hypotension between the DEX group (RR: 1.31; 95% CI: 0.85 to 2.02; p = 0.22; I 2 = 61%) and the control group ( Figure 5A ).…”

“…Eighteen studies (Jalowiecki et al, 2005a;Demiraran et al, 2007;Vázquez-Reta et al, 2011;Koksal et al, 2014;Lee et al, 2014;Samson et al, 2014;Wu et al, 2015;Goyal et al, 2016;Karanth et al, 2018;Kinugasa et al, 2018;Nonaka et al, 2018;Edokpolo et al, 2019;Yin et al, 2019;Ahmed et al, 2020;Algharabawy et al, 2021;Ashikari et al, 2021;Aminnejad et al, 2022;Chen et al, 2022) reported data concerning the risk of bradycardia, which was observed in 721 patients in the control group and 710 patients in the DEX group. There was a significant increase in bradycardia risk in the DEX group (RR: 3.08; 95% CI: 2.12 to 4.48; p < 0.00001; I 2 = 6%) compared with the control group (Figure 5B).…”

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

“…Nevertheless, they noted that serious adverse events in elderly patients were rare, and all complications were manageable. The results of Chen et al‘s study [ 26 ] revealed that a combination of dexmedetomidine and propofol for deep sedation in elderly patients candidate for ERCP can reduce sedation-related side effects and provide better hemodynamic conditions compared to propofol alone. Their reported rate of adverse events, including hypoxemia (4.2–36%), hypotension (16.7–60%), bradycardia (12-58.3%), and hypertension (16-20.8%), was higher than that of our study with different anesthesia protocols being possibly a key factor in this discrepancy.…”

Perbandingan Dexmedetomidine 1 mcg/kgBB Intravena Dan Fentanyl 2 mcg/kgBB Intravena Terhadap Mula Kerja, Efek Hemodinamik Dan Waktu Pulih Sadar Selama Anestesi Endoskopi Retrograde Cholangiopancreatography

“…Karakteristik sampel penelitian pada kedua kelompok dapat diketahui bahwa variabel umur dengan hasil median pada kelompok dexmedetomidine 47,4(22-64) dan kelompok fentanyl 44,9(26-64) dengan nilai p = 0,273. Untuk variabel jenis kelamin pada kelompok dexmedetomidine jumlah sampel laki-laki dan perempuan sebanyak 5 (23,8) dan 16 (76,2), sedangkan untuk kelompok fentanyl sebanyak 10 (47,6) dan 11 (52,4) dengan nilai p = 0,197. Berdasarkan hasil tersebut didapatkan bahwa hasil homogen.…”