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Current Drug Therapy

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ISSN (Print): 1574-8855
ISSN (Online): 2212-3903

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Research Article

Randomised Study Comparing the use of Propofol Versus Dexmedetomidine as a Sedative Agent for Patients Presenting for Lower Gastrointestinal Endoscopy

Author(s): Sameh A. Ahmed, Nehad Hawash, Fatma H. Rizk, Mahmoud Elkadeem, Mohamed Elbahnasawy and Sherief Abd-Elsalam*

Volume 15, Issue 1, 2020

Page: [61 - 66] Pages: 6

DOI: 10.2174/1574885514666190904161705

Price: $65

Abstract

Objectives: Dexmedetomidine, the alpha 2 agonist sedative and an analgesic agent may be beneficial in sedation for endoscopic intervention. Our aim was to compare the use of dexmedetomidine versus the traditional use of propofol as a sedative agent for colonoscopies.

Methods: This study included 100 patients presenting for elective colonoscopy under sedation with random and equal allocation of patients into two groups; group P, in which patients received propofol in a loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg/hr, and group D, in which patients received dexmedetomidine at a loading dose of 1ug/kg and maintenance dose of 0.5 ug/kg/hr. In addition to the demographic data, time to recovery, time of discharge, and endoscopist rating were measured. Also, the hemodynamic parameters were recorded, and also the incidence of postoperative complications.

Results: The basic patients' characteristics, time to recovery, and time of discharge were comparable between the two groups. Moreover, the endoscopist did not significantly report more convenient procedure with one group over the other. Also, there was no significant difference in hemodynamic parameters or in the incidence of complications between the two studied groups. However the use of dexmedetomidine decreased the incidence of hypoxemia.

Conclusion: The use of dexmedetomidine seems to have a similar effect to the use of propofol as a sedative agent for lower GIT endoscopy with the positive effect of dexmedetomidine in decreasing the incidence of perioperative hypoxemia.

Keywords: Dexmedetomidine, midazolam, sedation, anesthesia, colonoscopy, propofol.

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[1]
Strate LL, Syngal S. Timing of colonoscopy: Impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol 2003; 98(2): 317-22.
[PMID: 12591048]
[2]
Gayer C, Chino A, Lucas C, et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery 2009; 146(4): 600-6.
[http://dx.doi.org/10.1016/j.surg.2009.06.055] [PMID: 19789018]
[3]
Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96(4): 1004-17.
[http://dx.doi.org/10.1097/00000542-200204000-00031] [PMID: 11964611]
[4]
Faigel DO, Baron TH, Goldstein JL, et al. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc 2002; 56(5): 613-7.
[http://dx.doi.org/10.1016/S0016-5107(02)70104-1] [PMID: 12397263]
[5]
Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003; 58(3): 317-22.
[http://dx.doi.org/10.1067/S0016-5107(03)00001-4] [PMID: 14528201]
[6]
Singh H, Poluha W, Cheang M, et al. Propofol for sedation during colonoscopy. Cochrane database of systematic reviews 2008; 4: CD006268
[http://dx.doi.org/10.1002/14651858.CD006268]
[7]
Ahmed SA, Selim A, Hawash N, et al. Randomized controlled study comparing use of propofol plus fentanyl versus midazolam plus fentanyl as sedation in diagnostic endoscopy in patients with advanced liver disease. Int J Hepatol 2017; 2017: 8462756
[http://dx.doi.org/10.1155/2017/8462756] [PMID: 29312786]
[8]
Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology 2005; 129(5): 1384-91.
[http://dx.doi.org/10.1053/j.gastro.2005.08.014] [PMID: 16285939]
[9]
Külling D, Fantin AC, Biro P, Bauerfeind P, Fried M. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc 2001; 54(1): 1-7.
[http://dx.doi.org/10.1067/mge.2001.116174] [PMID: 11427833]
[10]
McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008; 67(6): 910-23.
[http://dx.doi.org/10.1016/j.gie.2007.12.046] [PMID: 18440381]
[11]
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 2008; 21(4): 457-61.
[http://dx.doi.org/10.1097/ACO.0b013e328305e3ef] [PMID: 18660652]
[12]
Afonso J, Reis F. Dexmedetomidine: Current role in anesthesia and intensive care. Rev Bras Anestesiol 2012; 62(1): 118-33.
[http://dx.doi.org/10.1016/S0034-7094(12)70110-1] [PMID: 22248773]
[13]
Shukry M, Kennedy K. Dexmedetomidine as a total intravenous anesthetic in infants. Paediatr Anaesth 2007; 17(6): 581-3.
[http://dx.doi.org/10.1111/j.1460-9592.2006.02171.x] [PMID: 17498022]
[14]
Ebert T, Maze M. Dexmedetomidine: Another arrow for the clinician’s quiver. Anesthesiology 2004; 101(3): 568-70.
[http://dx.doi.org/10.1097/00000542-200409000-00003] [PMID: 15329580]
[15]
Johnson OG, Taylor DM, Lee M, et al. Patient satisfaction with procedural sedation in the emergency department. Emerg Med Australas 2017; 29(3): 303-9.
[http://dx.doi.org/10.1111/1742-6723.12762] [PMID: 28371459]
[16]
Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology 2000; 93(5): 1345-9.
[http://dx.doi.org/10.1097/00000542-200011000-00030] [PMID: 11046225]
[17]
Ickeringill M, Shehabi Y, Adamson H, Ruettimann U. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy. Anaesth Intensive Care 2004; 32(6): 741-5.
[http://dx.doi.org/10.1177/0310057X0403200602] [PMID: 15648981]
[18]
Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59(2): 263-8.
[http://dx.doi.org/10.2165/00003495-200059020-00012] [PMID: 10730549]
[19]
Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc 2008; 67(4): 651-9.
[http://dx.doi.org/10.1016/j.gie.2007.09.041] [PMID: 18291396]
[20]
Techanivate A, Verawattaganon T, Saiyuenyong C, Areeruk P. A comparison of dexmedetomidine versus propofol on hypotension during colonoscopy under sedation. J Anesth Clin Res 2012; 3: 257.
[http://dx.doi.org/10.4172/2155-6148.1000257]
[21]
Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology 1992; 76(5): 725-33.
[http://dx.doi.org/10.1097/00000542-199205000-00010] [PMID: 1575340]
[22]
Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93(2): 382-94.
[http://dx.doi.org/10.1097/00000542-200008000-00016] [PMID: 10910487]
[23]
Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90(4): 834-9.
[http://dx.doi.org/10.1213/00000539-200004000-00011] [PMID: 10735784]
[24]
Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdzik P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005; 103(2): 269-73.
[http://dx.doi.org/10.1097/00000542-200508000-00009] [PMID: 16052108]
[25]
Vargo JJ. Propofol: A gastroenterologist’s perspective. Gastrointest Endosc Clin N Am 2004; 14(2): 313-23.
[http://dx.doi.org/10.1016/j.giec.2004.01.005] [PMID: 15121145]
[26]
Khan HA, Umar M, Tul-Bushra H, Nisar G, Bilal M, Umar S. Safety of non-anaesthesiologist-administered propofol sedation in ERCP. Arab J Gastroenterol 2014; 15(1): 32-5.
[http://dx.doi.org/10.1016/j.ajg.2014.01.011] [PMID: 24630512]
[27]
Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98(2): 428-36.
[http://dx.doi.org/10.1097/00000542-200302000-00024] [PMID: 12552203]
[28]
Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care 2000; 4(5): 302-8.
[http://dx.doi.org/10.1186/cc712] [PMID: 11056756]

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