Dexmedetomidine as a Sole Sedative Agent versus Propofol for Sedation during Upper and Lower Gastrointestinal Endoscopies by Alaa Ali Elzohry in Developments in Anaesthetics & Pain Management
Introduction and objectives: Diagnostic and therapeutic procedures recently are done in gastroenterology setup as a part of fast-track concept. A major volume of gastrointestinal procedures are performed routinely on daycare basis under sedation as upper and lower GIT endoscopy. Many anesthetic agents used to provide sedation for these procures. Propofol, opioids, and midazolam form the backbone of the various regimes employed in the endoscopic suites all over the world. Dexmedetomidine is a pharmacologically active selective α 2-adrenergic receptor agonist. It was approved it in the intensive care unit (ICU) for sedation and analgesia for the duration of less than 24 hours. The aim of this study was to study efficacy and safety of Dexmedetomidine efficacy as sole sedating agent versus propofol for sedation during upper and lower GIT endoscopy.
Methods: This randomized controlled trial was carried out on 60 patients of either sex, aged 21-70 years of age undergoing upper and lower GIT endoscopy, with ASA I-II. Patients were randomly assigned into two groups, (30 patients in each group).
Dex group: Sedation was induced by loading dose of (dexmedetomidine 1μg/kg) followed by infusion of (dexmedetomidine 0.8μg/kg /h) Propofol group: Sedation was initially started by bolus dose of 0.5mg/kg propofol IV Then, infusion was started at the rate of 50μg /kg/min. Upper and lower GIT endoscopies were carried out in the usual standard manner for all patients, then patients were discharged to PACU after attaining an Aldrete Recovery Scale Score of 9-10 Time taken to achieve this score was recorded. The patient’s vital signs, Respiratory complications, VAS score for pain measurement, PONV, and any other adverse events were recorded.
Results: There was significant decrease in (HR and MAP) but not respiration rate (RR) and SpO2, in (Dex group) during the procedure and early post-operative (P. value 0.000**). But during the remaining of post-operative periods (HR and MAP) were comparable. VAS pain scores in both groups were decreased in comparable manner at all measured time points. But complications (atthythmia, air way obstruction, nausea, and vomiting) was significantly increased in Propofol group (P. value 0.001**). Mean time to achieve RSS 3-4 was 6 (±1.5) min in Dex group versus 9 (±1.9) min in Propofol group (P< 0.005) and to achieve an Aldrete Recovery Scale Score of 9-10 was 8 (±2.1) min in Dex group versus 6 10 (±1.6) min in Propofol group (P< 0.029).
Conclusion: In conclusion, there is evidence to support dexmedetomidine as a potential sole sedative agent in small diagnostic and therapeutic procedures like GIT endoscopies, our study support these evidences and although dexmedetomidine resulted in longer onset and recovery, more side effects but sufficient levels of sedation and analgesia are good advantages to use it as sole sedating agent.
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