The Use of Propofol versus Dexmedetomidine for Patients Receiving Drug-Induced Sleep Endoscopy: A Meta-Analysis of Randomized Controlled Trials

Abstract

The sedation outcomes associated with dexmedetomidine compared with those of propofol during drug-induced sleep endoscopy (DISE) remains unclear. Electronic databases (i.e., the Cochrane controlled trials register, Embase, Medline, and Scopus) were searched from inception to 25 December 2020 for randomized controlled trials (RCTs) that evaluated the sedation outcomes with dexmedetomidine or propofol in adult patients diagnosed with obstructive sleep apnea (OSA) receiving DISE. The primary outcome was the difference in minimum oxygen saturation (mSaO2). Five RCTs (270 participants) published between 2015 and 2020 were included for analysis. Compared with dexmedetomidine, propofol was associated with lower levels of mSaO2 (mean difference (MD) = −7.24, 95% confidence interval (CI) −12.04 to −2.44; 230 participants) and satisfaction among endoscopic performers (standardized MD = −2.43, 95% CI −3.61 to −1.26; 128 participants) as well as a higher risk of hypoxemia (relative ratios = 1.82, 95% CI 1.2 to 2.76; 82 participants). However, propofol provided a shorter time to fall asleep and a lower risk of failed sedation compared with dexmedetomidine. No significant difference was found in other outcomes. Compared with propofol, dexmedetomidine exhibited fewer adverse effects on respiratory function and provided a higher level of satisfaction among endoscopic performers but was associated with an elevated risk of failed sedation.

Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial

“…Maybe these different effects of DEX are because of distinct loading and maintenance dose regimens. There are few studies regarding the administration of DEX in OSA patients and sedation [ 26 , 27 , 28 , 29 ]. Most of them compared it with propofol and showed better or similar results in respiratory effects.…”

The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

“…Dexmedetomidine, an alfa-2 adrenergic agonist with a predominantly central effect, seems a valid alternative to propofol, owing to its lower respiratory depressive action and the fact that it has no, or less, effect on arrhythmia inducibility [22][23][24][25][26][27]. The use of a multi-drug scheme has proved effective and safe in atrial fibrillation ablation [28][29][30].…”

New sedatives and analgesic drugs for gastrointestinal endoscopic procedures

“…There are several review articles and meta-analyses of dexmedetomidine in the field of endoscopic sedation. [13][14][15][16] The usual dose used for sedation is 1 μg/kg for 6−10 minutes, followed by an intravenous infusion of 0.5−0.8 μg/kg/hr. However, some patients may require combined sedation with midazolam (0.5−1 mg).…”

“…Although dexmedetomidine has fewer adverse effects on respiratory function than propofol, it bears the risk of inducing insufficient sedation during endoscopic procedures. 14 , 15 , 20 In summary, dexmedetomidine may be useful for diagnostic endoscopy; additional agents, such as midazolam or fentanyl, may be required for more time-consuming procedures such as therapeutic endoscopy. Considering all of these, dexmedetomidine was approved in December 1999 by the FDA as a short-term sedative and analgesic.…”