Efficacy of a Dexmedetomidine–Remifentanil Combination Compared with a Midazolam–Remifentanil Combination for Conscious Sedation During Therapeutic Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Randomized, Single-Blinded Preliminary Trial

Zhiqiang, Liang; Li, Wenyuan; Chen, Huiyu; Qian, Yanning

doi:10.1007/s10620-018-5034-3

Cited by 27 publications

(25 citation statements)

References 24 publications

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“…There were no patients whose examination was suspended due to respiratory suppression in the dexmedetomidine hydrochloride group. Reports indicated that the combined use of dexmedetomidine hydrochloride with sedatives/analgesics reduced the additional administration and total administered dose of sedatives, as well as the frequency of SpO 2 decrease 6–8 …”

Section: Cq 19: Is Dexmedetomidine Hydrochloride Effective In Sedatiomentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy (second edition)

Gotoda

Akamatsu

Abe

et al. 2020

Digestive Endoscopy

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Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release upto-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.

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Section: Cq 19: Is Dexmedetomidine Hydrochloride Effective In Sedatiomentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy (second edition)

Gotoda

Akamatsu

Abe

et al. 2020

Digestive Endoscopy

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“…fects without inducing respiratory depression. Also, it reduces anesthetic requirement during intraoperative period and provides hemodynamic stability [14][15][16] . The alpha-2 receptors localized in the blood vessels mediate vasoconstriction and those located at sympathetic terminals play a role in the regulation of the autonomic and cardiovascular system by inhibiting norepinephrine release.…”

Section: Discussionmentioning

confidence: 99%

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

Ar¹

2018

Haydarpasa Numune Med J

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Introduction: In this study, we aim to investigate the effects of two different preanesthetic doses of dexmedetomidine on the hemodynamic response to endotracheal intubation, intubation conditions and neuromuscular block. Methods: Seventy-five ASAI-II patients, aged 18-70 years, who required tracheal intubation for elective surgery were allocated for this study. Before induction, patients were randomly divided into three groups to receive either saline as placebo (20cc) (GroupC), dexmedetomidine 0.5 μg/kg (Group D0.5) or dexmedetomidine 1 μg/kg (Group D1) in a total volume of 20 cc in 10 min. Heart rate(HR) and mean arterial pressure (MAP) were recorded according to the study's measurement time. Time to achieve 90% and 100% neuromuscular block, time to recovery from neuromuscular block 25% (T25), 50% (T50), 75% (T75) and recovery index values were noted. Results: The increases in HR after laryngoscopy and immediately intubation were lower in both groups D than Group C. Values of MAP during laryngoscopy were lower in both Groups D than Group C Times to achieve 90% and 100% neuromuscular block were found significantly lower in dexmedetomidine groups than Group C. Values of T75 and recovery index in Group D 0.5, T25, T50, T75 and recovery index in Group D1 were longer than Group C. Neuromuscular block properties were similar between dexmedetomidine groups. Discussion and Conclusion: We conclude that dexmedetomidine decreased hemodynamic response to endotracheal intubation, especially heart rate dose-dependently, whereas it decreased time to achieve neuromuscular block and increased time to recovery from the neuromuscular block as independent from dose.

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“…Another study showed that the dexmedetomidine-remifentanil protocol improved respiratory sparing effects to a greater extent than midazolam-remifentanil. Therefore, the dexmedetomidine-remifentanil regimen can be used safely as a sedation method during endoscopic retrograde cholangiopancreatography (ERCP) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that when dexmedetomidine and remifentanil were used together, safe and satisfactory sedation was provided [ 9 10 ]. However, the appropriate concentration of remifentanil during plate removal of maxilla was not suggested.…”

Section: Introductionmentioning

confidence: 99%

Optimal effective-site concentration of remifentanil for sedation during plate removal of maxilla

Park

Yoon

Kim

et al. 2018

J Dent Anesth Pain Med

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BackgroundRemoval of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration (Ce50) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine.MethodsThe study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of 1.0 µg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.7 µg/kg/h. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed.ResultsThe Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively.ConclusionsPlate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration (Ce50, 1.28 ng/mL; Ce95, 2.51 ng/mL) combined with sedation using dexmedetomidine.

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Efficacy of a Dexmedetomidine–Remifentanil Combination Compared with a Midazolam–Remifentanil Combination for Conscious Sedation During Therapeutic Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Randomized, Single-Blinded Preliminary Trial

Cited by 27 publications

References 24 publications

Guidelines for sedation in gastroenterological endoscopy (second edition)

Guidelines for sedation in gastroenterological endoscopy (second edition)

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

Optimal effective-site concentration of remifentanil for sedation during plate removal of maxilla

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