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Tang R, Huang Y, Zhang Y, Ma X, Yu H, Song K, Ren L, Zhao B, Wang L, Zheng W. Efficacy and safety of sedation with dexmedetomidine in adults undergoing gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2023; 14:1241714. [PMID: 38034988 PMCID: PMC10684920 DOI: 10.3389/fphar.2023.1241714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background: The sedative role of dexmedetomidine (DEX) in gastrointestinal endoscopic procedures is unclear. We performed this systematic review and meta-analysis to assess the efficacy and safety of sedation with DEX during gastrointestinal endoscopic procedures with a view to providing evidence-based references for clinical decision-making. Methods: The PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) that compared DEX with different sedatives comparators (such as propofol, midazolam, and ketamine) for sedation in a variety of adult gastrointestinal endoscopic procedures from inception to 1 July 2022. Standardized mean difference (SMD) and weighted mean difference (WMD) with 95% confidence interval (CI) or pooled risk ratios (RR) with 95% CI were used for continuous outcomes or dichotomous outcomes, respectively, and a random-effect model was selected regardless of the significance of the heterogeneity. Results: Forty studies with 2,955 patients were assessed, of which 1,333 patients were in the DEX group and 1,622 patients were in the control (without DEX) group. The results suggested that the primary outcomes of sedation level of DEX are comparable to other sedatives, with similar RSS score and patient satisfaction level, and better in some clinical outcomes, with a reduced risk of body movements or gagging (RR: 0.60; 95% CI: 0.37 to 0.97; p = 0.04; I2 = 68%), and a reduced additional requirement for other sedatives, and increased endoscopist satisfaction level (SMD: 0.41; 95% CI: 0.05 to 0.77; p = 0.03; I2 = 86%). In terms of secondary outcomes of adverse events, DEX may benefit patients in some clinical outcomes, with a reduced risk of hypoxia (RR:0.34; 95% CI: 0.20 to 0.55; p < 0.0001; I2 = 52%) and cough (RR: 0.25; 95% CI: 0.12 to 0.54; p = 0.0004; I2 = 0%), no significant difference in the risk of hypotension, while an increased risk of bradycardia (RR: 3.08; 95% CI: 2.12 to 4.48; p < 0.00001; I2 = 6%). Conclusion: This meta-analysis indicates that DEX is a safe and effective sedative agent for gastrointestinal endoscopy because of its benefits for patients in some clinical outcomes. Remarkably, DEX is comparable to midazolam and propofol in terms of sedation level. In conclusion, DEX provides an additional option in sedation for gastrointestinal endoscopic procedures. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#searchadvanced.
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Affiliation(s)
- Rou Tang
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China
| | - Yaqun Huang
- Department of Pharmacy, Hospital of Honghe State Affiliated to Kunming Medical University, Southern Central Hospital of Yunnan Province, Mengzi, China
| | - Yujia Zhang
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Ma
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyang Yu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Kaichao Song
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Ren
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China
| | - Lulu Wang
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wensheng Zheng
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lorenz P, Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Koop I, Fischer N, Jansen PL. Leitlinienreport der aktualisierten S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e628-e653. [PMID: 37678314 DOI: 10.1055/a-2124-5746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Till Wehrmann
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Andrea Riphaus
- Innere Medizin, St. Elisabethen Krankenhaus Frankfurt Artemed SE, Frankfurt, Deutschland
| | - Alexander J Eckardt
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Peter Klare
- Abteilung Innere Medizin Gastroenterologie, Diabetologie und Hämato-/Onkologie, Krankenhaus Agatharied, Hausham, Deutschland
| | - Ina Koop
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Deutschland
| | - Nadine Fischer
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
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Fonseca FJ, Ferreira L, Rouxinol-Dias AL, Mourão J. Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:641-664. [PMID: 34933035 PMCID: PMC10533981 DOI: 10.1016/j.bjane.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. METHODS A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. RESULTS A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I² = 60%). CONCLUSION DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.
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Affiliation(s)
| | - Leonardo Ferreira
- São João University Hospital Center, Department of Anesthesiology, Porto, Portugal.
| | - Ana Lídia Rouxinol-Dias
- São João University Hospital Center, Department of Anesthesiology, Porto, Portugal; Faculty of Medicine of the University of Porto, Department of Community Medicine, Information and Decision in Health, MEDCIDS, Porto, Portugal; Faculty of Medicine of the University of Porto, Center for Health Technology and Services Research, CINTESIS, Porto, Portugal
| | - Joana Mourão
- Faculty of Medicine of the University of Porto, Porto, Portugal; São João University Hospital Center, Department of Anesthesiology, Porto, Portugal
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Sriramka B, Awal S, Mallik D, Narayan J. Nebulised dexmedetomidine for patient's comfort and satisfaction during diagnostic upper gastrointestinal endoscopy: A double-blind randomised controlled study. Indian J Anaesth 2023; 67:825-827. [PMID: 37829790 PMCID: PMC10566668 DOI: 10.4103/ija.ija_393_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Bhavna Sriramka
- Department of Anesthesia and Critical Care, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Shikha Awal
- Department of Anesthesia and Critical Care, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Diptimayee Mallik
- Department of Anesthesia and Critical Care, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Jimmy Narayan
- Department of Medical Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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Ayatollahi V, Mansourimanesh M, Hatami M, Atighechi S, Vaziribozorg S, Saeidieslami N. Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:3824-3831. [PMID: 36742531 PMCID: PMC9895657 DOI: 10.1007/s12070-021-02622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction We decided to compare dexmedetomidine with propofol regarding several anesthetic and surgical aspects, during stapedotomy done under conscious sedation. Materials and Method Thirty patients aged 20-50 years with (American Society of Anesthesiology) ASA class I-II, were assigned to two groups of propofol and dexmedetomidine using a random number table. In dexmedetomidine group, patients received dexmedetomidine infusion (0.5 µg/kg/h) and in the control group, propofol was administered (3 mg/kg/h).Time to reach the desired Ramsey Sedation Score (RSS) and time to reach Aldrete score ≥ 9; incidence of inadvertent movement and amnesia; as well as patients' and surgeons' level of satisfaction and degree of bleeding was recorded. Data on hemodynamic variables were monitored and recorded at several intervals. Results The mean time taken to reach the RSS (2-4) was 10.3 ± 2.1 min in dexmedetomidine group and 3.1 ± 1.2 min in propofol group. Time to reach Aldrete score ≥ 9 for patients sedated with dexmedetomidine was 8.6 ± 2.1 min and for propofol group was 4.6 ± 1.4 min (p value < 0.05).There were also significant differences between two groups in terms of surgeon's satisfaction with sedation, and the amount of intra operative bleeding. Conclusion According to the results of this study, it can be concluded that dexmedetomidine is a better choice for conscious sedation than propofol. However, the time to reach the required sedation in the dexmedetomidine group was significantly longer.
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Affiliation(s)
- Vida Ayatollahi
- Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahzad Mansourimanesh
- Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Hatami
- Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeid Atighechi
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sedighe Vaziribozorg
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasir Saeidieslami
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Hu F, Zou L, Chang H, Tian L, Liu F, Lan Y, Zhang F, Liu X. Comparison of effectiveness, cost and safety between moderate sedation and deep sedation under esophagogastroduodenoscopy in Chinese population: a quasi-experimental study. Scand J Gastroenterol 2022; 57:1105-1111. [PMID: 35403537 DOI: 10.1080/00365521.2022.2060050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Most endoscopists routinely perform moderate or deep sedation for esophagogastroduodenoscopy (EGD). Considering that there is no consensus on the optimal sedation depth and it varies from country to country, our study aims to compare the effectiveness, cost and safety of these two sedation methods in the Chinese population. METHODS This quasi-experimental study included a total of 556 eligible patients from July 2020 to June 2021, and they entered the moderate sedation group or deep sedation group based on their choices. Baseline information, scores of Patient Satisfaction with Sedation Instrument (PSSI) and Clinician Satisfaction with Sedation Instrument (CSSI), examination time, sedation time, recovery time, expenses before medicare reimbursement, hypoxaemia and hypotension were compared between the two groups. Propensity Score Matching (PSM) analysis was conducted to balance the confounding factors. RESULTS After PSM, 470 patients were involved in the analysis, with 235 for each group. The moderate sedation was clearly superior to the deep sedation group in terms of PSSI score (98.00 ± 0.94 vs. 97.29 ± 1.26), CSSI score (98.00 ± 0.78 vs. 97.67 ± 1.30), sedation time (11.90 ± 2.04 min vs. 13.21 ± 2.75 min), recovery time (25.40 ± 3.77 min vs. 28.0 ± 4.85 min), expenses (433.04 ± 0.00 Yuan vs. 789.85 ± 0.21 Yuan), with all p < .001. Examination time was not significantly different between the two groups (p = .124). In addition, the moderate sedation group had a lower occurrence rate of hypoxaemia (0.36% vs. 3.27%, p = .010) and hypotension (17.44% vs. 44.00%, p < .001) compared to the deep sedation group. CONCLUSIONS Moderate sedation presented better effectiveness and safety and lower cost, and thereby it should be recommended as a widely used sedation method in clinical practice in China. Trial registration: This trial was registered on http://www.chictr.org.cn/index.aspx (ChiCTR2000038050).
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Affiliation(s)
- Feng Hu
- Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Long Zou
- Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Hongxia Chang
- Department of Anesthesiology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Lin Tian
- Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Fanrong Liu
- Endoscopy Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Ya Lan
- Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China
| | - Fangxin Zhang
- Department of Gastroenterology, Xi'an International Medical Center Hospital, Xi'an, P. R. China
| | - Xiao Liu
- Department of Gastroenterology, Xi'an International Medical Center Hospital, Xi'an, P. R. China
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Yanan J, Hui D, Jianwei G, Ronglin L, Lijuan Z, Jing Z. A Comparative Study on Sedation Efficacy Between General and Regional Anesthesia with Dexmedetomidine in Patients Under Maxillofacial Surgery. Curr Drug Metab 2022; 23:920-927. [PMID: 35422208 DOI: 10.2174/1389200223666220413113412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Securing the airway in the surgery of maxillofacial disorders and traumas is fundamental during the operation. The present study aims to investigate the beneficial sedative effects of dexmedetomidine (DEX) in patients who underwent maxillofacial surgery with regional anesthesia compared to general anesthesia. METHODS Fifty patients, aged 20-45 years old were randomly divided into two groups of regional anesthesia (RA) and general anesthesia (GA) (each n=25). The group RA received regional block with sedation (DEX: 1 μg/kg infused over 10 min followed by the maintenance dose of 0.5 μg/kg/h) and the group GA underwent general anesthesia (DEX: 0.1 μg/kg/min over 10 min followed by 0.4-0.7 μg/kg/h). Postoperative pain scores, anesthesia outcomes, hemodynamic parameters, the time of the post-anesthesia care unit (PACU) discharge and intra and postoperative complications were comparatively assessed in both groups. RESULTS The baseline characteristics of the patients (age, gender, BMI, and ASA physical status) showed no differences between the two groups (P>0.05). Although the duration of surgery and recovery time showed no differences between the groups, the duration of anesthesia and extubation time was remarkably lower in the RA group than in the GA group (P<0.01). Administration of nerve blocks demonstrated less pain and longer sleep time in the postoperative phase as compared to the GA group. Heart rate and mean arterial blood pressure were significantly less in the RA group at the end of the loading dose of DEX and incision time (P<0.05). SpO2, respiration rate and Ramsay sedation scale did not exhibit any significant differences between the two groups at all-time points (P>0.05). No significant differences were observed with regard to the adverse events between the two groups (P>0.05). CONCLUSIONS Although our findings revealed that both methods are suitable and safe methods for maxillofacial surgery, the outcomes of anesthesia with regional block and sedation include less pain in the postoperative phase, shorter extubation time and earlier discharge from the PACU demonstrated that this method is more reliable for maxillofacial surgery. Further controlled studies are needed to compare the effectiveness and safety profiles of two RA and GA techniques and also to compare DEX with other anesthetic agents to achieve optimum outcomes in maxillofacial surgeries.
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Affiliation(s)
- Jiang Yanan
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Ding Hui
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Guo Jianwei
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Liu Ronglin
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Zhu Lijuan
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Zhao Jing
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
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Chen M, Sun Y, Li X, Zhang C, Huang X, Xu Y, Gu C. 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. BMC Anesthesiol 2022; 22:85. [PMID: 35346041 PMCID: PMC8961946 DOI: 10.1186/s12871-022-01630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
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).
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Affiliation(s)
- Mo Chen
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Yi Sun
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Xueyan Li
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Chun Zhang
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Xiaochen Huang
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Yiming Xu
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Chengyong Gu
- Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China.
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Aminnejad R, Hormati A, Shafiee H, Alemi F, Hormati M, Saeidi M, Ahmadpour S, Sabouri SM, Aghaali M. Comparing the efficacy and safety of Dexmedetomidine/Ketamine with Propofol/Fentanyl for sedation in colonoscopy patients: A double-blinded randomized clinical trial. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:724-731. [PMID: 34620069 DOI: 10.2174/1871527320666211006141406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this double-blinded randomized clinical trial, we aimed to compare the safety and efficacy of a combination of dexmedetomidine and ketamine [DK] with propofol and fentanyl [PF] for sedation in colonoscopy patients. METHODS In this study, 64 patients who underwent colonoscopy were randomized into two groups: 1) A, which received PF, and 2) B, which received DK for sedation. Among 64 patients, 31 patients were included in PF, and 33 patients were included in the DK group. Both groups were similar in terms of demographics. Patients' sedation score (based on Ramsay sedation scale) and vital signs were recorded at 2, 5, 10, and 15 minutes. Complications including apnea, hypotension, hypoxia, nausea, and vomiting, along with gastroenterologist satisfaction and patients' pain score (based on Wong-Baker faces pain assessment scale), were recorded by a checklist. Data were analyzed by SPSS v.18 software, using chi-square, independent t-tests, and repeated measures analysis with p<0.05 as the criterion for significant differences. RESULTS The mean score of sedation was 4.82±0.49 in the DK group and 5.22±0.45 in the PF group [p value=0.001]. Serious complications, including hypotension [p value=0.005] and apnea [p value=0.10] were significantly higher in the PF group. Satisfaction of gastroenterologist [p value= 0.400] and patients' pain score [p value = 0.900] were similar among groups. CONCLUSION Combination of DK provides sufficient sedation with fewer complications in comparison with PF in colonoscopy patients.
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Affiliation(s)
- Reza Aminnejad
- Department of Anesthesiology, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom. Iran
| | - Ahmad Hormati
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran. Iran
| | | | - Faezeh Alemi
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom. Iran
| | | | | | - Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom. Iran
| | - Seyed Mahdi Sabouri
- Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom. Iran
| | - Mohammad Aghaali
- Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom. Iran
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Liu W, Yu W, Yu H, Sheng M. Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis. J Int Med Res 2021; 49:3000605211032786. [PMID: 34308693 PMCID: PMC8320575 DOI: 10.1177/03000605211032786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy and safety of dexmedetomidine and propofol in patients who underwent gastrointestinal endoscopy. METHODS Relevant studies comparing dexmedetomidine and propofol among patients who underwent gastrointestinal endoscopy were retrieved from databases such as PubMed, Embase, and Cochrane Library. RESULTS Seven relevant studies (dexmedetomidine group, n = 238; propofol group, n = 239) met the inclusion criteria. There were no significant differences in the induction time (weighted mean difference [WMD] = 3.46, 95% confidence interval [CI] = -0.95-7.88, I2 = 99%) and recovery time (WMD = 2.74, 95% CI = -2.72-8.19, I2 = 98%). Subgroup analysis revealed no significant differences in the risks of hypotension (risk ratio [RR] = 0.56, 95% CI = 0.25-1.22) and nausea and vomiting (RR = 1.00, 95% CI = 0.46-2.22) between the drugs, whereas dexmedetomidine carried a lower risk of hypoxia (RR = 0.26, 95% CI = 0.11-0.63) and higher risk of bradycardia (RR = 3.01, 95% CI = 1.38-6.54). CONCLUSIONS Dexmedetomidine had similar efficacy and safety profiles as propofol in patients undergoing gastrointestinal endoscopy.
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Affiliation(s)
- Weihua Liu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Hongli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Mingwei Sheng
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, P.R. China
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Paul M, Rastogi A, Chatterje A, Agarwal A, Mishra P, Khan A. Comparative evaluation of propofol and combination of propofol-dexmedetomidine in adjunct with topical airway anesthesia for rigid bronchoscopy: A randomized double-blinded prospective study. Ann Card Anaesth 2021; 24:49-55. [PMID: 33938832 PMCID: PMC8081131 DOI: 10.4103/aca.aca_45_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Rigid bronchoscopy (RB) procedures require continuous vigilance and monitoring. Such procedures warrant proper ventilation strategy and titration of potent short-acting anesthetics. Aims: To compare propofol with the propofol-dexmedetomidine in conjunction with topical airway anesthesia in two groups during spontaneous assisted ventilation on peri-procedural hemodynamic stability. Settings and Design: This prospective, randomized, double-blinded study was done on 40 patients who were randomized in two groups, 20 patients in each group; PS (Propofol+ Normal saline) and PD (Propofol+ Dexmedetomidine) group. All patients in both groups were induced with 1% IV propofol (1–3 mg/kg), IV midazolam (0.05 mg/kg), and IV fentanyl (2 μ/kg). PS group received propofol infusion for maintenance along with saline infusion 10 min before induction, whereas PD group also received propofol infusion for maintenance along with Injection dexmedetomidine infusion 10 min before induction. Outcome measured were heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), and post-procedure awakening using Modified Observer's Assessment of Alertness/Sedation (MOAAS) scale and complications. Results: In both the groups, MBP decreased significantly from baseline, however, when MBP were compared at the same time points between the groups there were no significant differences. In PD group, HR remained significantly lower when compared with baseline and at 6, 12, 18, and 24 min time points when compared with PS group. Number of patients who developed hypotension requiring vasoactive drugs, their mean dose and duration of hypotension were more in PD group, and they awoke with significant delay. Conclusions: Propofol is better than combination of propofol and dexmedetomidine when given in adjunct with topical airway anesthesia for RB in view of early awakening, lesser duration of intra-procedural hypotension, and lesser requirement of vasoactive agents.
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Affiliation(s)
- Mekhla Paul
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Amit Rastogi
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Arindam Chatterje
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Aarti Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
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12
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Tekeli AE, Oğuz AK, Tunçdemir YE, Almali N. Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy. Medicine (Baltimore) 2020; 99:e23317. [PMID: 33285707 PMCID: PMC7717792 DOI: 10.1097/md.0000000000023317] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy. METHODS The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses. RESULTS In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation. CONCLUSION Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.
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Affiliation(s)
- Arzu Esen Tekeli
- Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine
| | - Ali Kendal Oğuz
- Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine
| | - Yunus Emre Tunçdemir
- Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine
| | - Necat Almali
- Department of General Surgery, Van Yuzuncu Yil University School of Medicine, Van, Turkey
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13
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Effects of spinal anesthesia and sedation with dexmedetomidine or propofol on cerebral regional oxygen saturation and systemic oxygenation a period after spinal injection. J Anesth 2020; 34:806-813. [PMID: 32556601 DOI: 10.1007/s00540-020-02816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate changes in cerebral regional oxygen saturation (rSO2) after spinal anesthesia and compare the changes in rSO2 and systemic oxygenation between dexmedetomidine sedation and propofol sedation. METHODS Thirty-six patients scheduled to undergo transurethral surgery under spinal anesthesia were randomly assigned to the dexmedetomidine (n = 18) and propofol groups (n = 18). We used near-infrared spectroscopy sensors to measure rSO2, and obtained data from each side were averaged. After oxygen insufflation, baseline measurements of mean arterial blood pressure (MAP), heart rate, rSO2, pulse oximetry saturation (SpO2), bispectral index, and body temperature were made. After spinal anesthesia, we measured these parameters every 5 min. Twenty minutes after spinal injection, dexmedetomidine or propofol administration was started. We measured each parameter at 10, 25, and 40 min after the administration of dexmedetomidine or propofol. RESULTS The baseline rSO2 in the dexmedetomidine group was 71.3 ± 7.3%, and that in the propofol group was 71.8 ± 5.6%. After spinal anesthesia, rSO2 in both groups decreased significantly (dexmedetomidine group: 65.4 ± 6.9%; propofol group: 64.3 ± 7.4%). After administering sedatives, rSO2 was equivalent after spinal anesthesia. rSO2 was comparable between the two groups. MAP and SpO2 were significantly higher in the dexmedetomidine group than in the propofol group. CONCLUSION Spinal anesthesia decreased rSO2; however, the decline was not severe. Dexmedetomidine and propofol did not compromise cerebral oxygenation under spinal anesthesia. Nevertheless, MAP and SpO2 were more stable in dexmedetomidine sedation than in propofol sedation. Dexmedetomidine may be suitable for spinal anesthesia.
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14
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Tang Y, Yang M, Fu F, Huang X, Feng Y, Chen X. Comparison of the ED50 of intrathecal hyperbaric ropivacaine co-administered with or without intrathecal dexmedetomidine for cesarean section: A prospective, double-blinded, randomized dose-response trial using up-down sequential allocation method. J Clin Anesth 2020; 62:109725. [PMID: 32036258 DOI: 10.1016/j.jclinane.2020.109725] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/16/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Studies have showed that intrathecal dexmedetomidine as supplements to local anesthetics can improve the quality of the spinal anesthesia and reduce the local anesthetic requirement of spinal anesthesia for cesarean section. However, the magnitude of this effect has not been fully quantified. Therefore, we conducted the present study to investigate the ED50 of intrathecal hyperbaric ropivacaine with or without dexmedetomidine for cesarean section in healthy parturients. ED50 values obtained were compared to estimate the effect of intrathecal dexmedetomidine versus placebo on ropivacaine requirement. DESIGN Single-blinded, prospective, randomized study. SETTING Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine. PATIENTS Sixty healthy parturients under elective cesarean section with combined spinal-epidural anesthesia were randomized into Group C (intrathecal ropivacaine alone) and Group D (intrathecal ropivacaine + 5 μg dexmedetomidine). INTERVENTIONS The dose of intrathecal ropivacaine for the first parturient in both groups was 11 mg. An increment or decrement of 0.5 mg intrathecal ropivacaine was made for the subsequent parturient based on the effective or ineffective response of the previous parturient. Effective dose was defined as a bilateral T6 or above sensory block level was achieved within 15 min after induce of spinal anesthesia and no additional epidural anesthetics was required during surgery. The Dixon and Massay sequential method and Probit regression were applied to calculate the ED50 of intrathecal ropivacaine in both groups. MEASUREMENTS Characteristics of spinal anesthesia and side effects were recorded. MAIN RESULTS The ED50 of hyperbaric ropivacaine calculated by Dixon and Massay formula was 11.4 mg (95% CI, 11.1-11.7 mg) in Group C, and 9.4 mg (95% CI, 9.0-9.7 mg) in Group D (P < 0.05). While using the Probit regression, the ED50 of intrathecal hyperbaric ropivacaine was 11.1 mg (95% CI, 10.7-11.6 mg) in Group C, and 9.1 mg (95% CI, 8.6-9.5 mg) in Group D. Shivering was less observed in Group D than in Group C (P < 0.05). There was no significant difference in the onset time of sensory block or motor block, the incidence of hypotension, bradycardia, nausea and vomiting, sedation and pruritus between the two groups. CONCLUSION Under the conditions of the present study, intrathecal dexmedetomidine (5 μg) reduced the ED50 of intrathecal hyperbaric ropivacaine by approximately 18% for cesarean section in healthy parturients under combined spinal-epidural anesthesia.
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Affiliation(s)
- Yuwen Tang
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, Zhejiang 310006, China
| | - Meijuan Yang
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, Zhejiang 310006, China
| | - Feng Fu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, Zhejiang 310006, China
| | - Xiaodong Huang
- Department of Anesthesia, Hangzhou Women's Hospital, Kunpeng Road 369#, Hangzhou, Zhejiang 310008, China
| | - Ying Feng
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, Zhejiang 310006, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, Zhejiang 310006, China.
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15
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Dexmedetomidine added to propofol for drug-induced sleep endoscopy in adult patients with obstructive sleep apnea: Randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Schacherer NM, Armstrong T, Perkins AM, Poirier MP, Schmidt JM. Propofol Versus Dexmedetomidine for Procedural Sedation in a Pediatric Population. South Med J 2019; 112:277-282. [PMID: 31050796 DOI: 10.14423/smj.0000000000000973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Frequently, infants and children require sedation to facilitate noninvasive procedures and imaging studies. Propofol and dexmedetomidine are used to achieve deep procedural sedation in children. The objective of this study was to compare the clinical safety and efficacy of propofol versus dexmedetomidine in pediatric patients undergoing sedation in a pediatric sedation unit. METHODS A retrospective analysis of patients sedated with either propofol or dexmedetomidine in a pediatric sedation unit by pediatric emergency physicians was performed. Both medications were dosed per protocol with propofol 2 mg/kg induction and 150 μg · kg-1 · min-1 maintenance and dexmedetomidine 3 μg/kg induction for 10 minutes and 2 μg · kg-1 · h-1maintenance. The variables collected included drug dose, sedation time (time that the drug was given to the completion of the procedure), recovery time (end of the study to the return to the presedation sedation score for 15 minutes), need for dose rate changes, airway management, and adverse events. RESULTS A total of 2432 children were included- 1503 who received propofol and 929 who received dexmedetomidine. Propofol and dexmedetomidine resulted in successful completion of the study in 98.8% and 99.7%, respectively (P = 0.02). The mean recovery time for propofol was 34.3 minutes, compared with 65.6 minutes for dexmedetomidine (P < 0.001). The need for unexpected airway management was 9.7% for propofol and 2.2% for dexmedetomidine (P < 0.001). Adverse events occurred in 8.6% and 6% of patients in the propofol and dexmedetomidine groups, respectively (P = 0.02). CONCLUSIONS Propofol use led to significantly shorter recovery times, with an increased need for airway management, but rates of bag-mask ventilation (2.3%), airway obstruction (1.1%), and desaturation (1.6%) were low. No patients required intubation. Propofol is a reasonable alternative to dexmedetomidine, with a clinically acceptable safety profile.
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Affiliation(s)
- Nicole M Schacherer
- From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tamara Armstrong
- From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amy M Perkins
- From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael P Poirier
- From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James M Schmidt
- From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
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17
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Brant JM, Stringer L, Jurkovich LR, Coombs NC, Mullette EJ, Buffington C, Herbert S, Karera D. Predictors of oversedation in hospitalized patients. Am J Health Syst Pharm 2018; 75:1378-1385. [DOI: 10.2146/ajhp170558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jeannine M. Brant
- Center for Clinical Translational Research, Billings Clinic, Billings, MT
| | - Lee Stringer
- Stringer Healthcare Consultants, Fort Lauderdale, FL
| | | | - Nicholas C. Coombs
- Center for Clinical Translational Research, Billings Clinic, Billings, MT
| | | | | | | | - David Karera
- Department of Anesthesia, New York Medical College, Valhalla, NY
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18
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Nishizawa T, Suzuki H, Arita M, Kataoka Y, Fukagawa K, Ohki D, Hata K, Uraoka T, Kanai T, Yahagi N, Toyoshima O. Pethidine dose and female sex as risk factors for nausea after esophagogastroduodenoscopy. J Clin Biochem Nutr 2018; 63:230-232. [PMID: 30487674 PMCID: PMC6252297 DOI: 10.3164/jcbn.18-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/22/2018] [Indexed: 12/11/2022] Open
Abstract
Nausea and vomiting after esophagogastroduodenoscopy have not been studied in detail. The aim of this study was to evaluate the risk factors for post-endoscopic nausea. We performed a case-control study at the Toyoshima Endoscopy Clinic. Eighteen patients with post-endoscopic nausea and 190 controls without post-endoscopic nausea were analyzed. We conducted univariate and multivariate logistic regression analyses with respect to patient age; sex; body height; body weight; the use of psychotropic drugs as baseline medications; and the dosing amounts of midazolam, pethidine, flumazenil and naloxone. On univariate analysis, post-endoscopic nausea was significantly related with patient age (odds ratio = 0.946); female sex (odds ratio = 10.85); body weight (odds ratio = 0.975); and the dose per kg body weight of pethidine (odds ratio = 53.03), naloxone (odds ratio = 1.676), and flumazenil (odds ratio = 1.26). On multivariate analysis, the dose per kg body weight of pethidine (odds ratio = 21.67, p = 0.004) and female sex (odds ratio = 13.12, p = 0.047) were the factors independently associated with post-endoscopic nausea. The prevalence of nausea after esophagogastroduodenoscopy was 0.49% (18/3,654). In conclusion, post-endoscopic nausea was associated with the dose of pethidine and female sex.
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Affiliation(s)
- Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.,Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masahide Arita
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan
| | - Yosuke Kataoka
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazushi Fukagawa
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Daisuke Ohki
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Keisuke Hata
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.,Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Osamu Toyoshima
- Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan
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19
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Weatherall M, Aantaa R, Conti G, Garratt C, Pohjanjousi P, Lewis MA, Moore N, Perez-Gutthann S. A multinational, drug utilization study to investigate the use of dexmedetomidine (Dexdor®) in clinical practice in the EU. Br J Clin Pharmacol 2017; 83:2066-2076. [PMID: 28345249 PMCID: PMC5555873 DOI: 10.1111/bcp.13293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 03/08/2017] [Accepted: 03/17/2017] [Indexed: 01/27/2023] Open
Abstract
Aims Dexmedetomidine (dexdor®) is approved in the European Union (EU) for sedation of adults in the intensive care unit (ICU). The present observational, retrospective study was requested by the European Medicines Agency to investigate dexmedetomidine use in clinical practice, with a particular focus on off‐label use, including the paediatric population. Methods Study countries and sites were chosen from those with highest dexmedetomidine use, based on sales. Site selection (blind) was conducted by a multispecialist, independent group. Anonymized data on demographics, treatment indication, dexmedetomidine dosing, concomitant medications and treatment effectiveness were collected retrospectively from records of all dexmedetomidine‐treated patients at the site during the enrolment period. Informed consent was waived, to avoid influencing the prescribing of dexmedetomidine. Recruitment was completed within 18 months of first site initiation. Results Data from 2000 patients were collected from 16 hospitals in four EU countries (Finland 750, Poland 505, Germany 470, Austria 275). The median age was 62 years, with more males (70.2%) than females. Dexmedetomidine was primarily used in the adult ICU (86.0%) for ICU sedation (78.6%) and mostly dosed according the product label. The intended sedative effect was obtained in 84.9% of administrations. Paediatric use (5.9% of patients, mostly in Austria and Finland) occurred mainly in the adult or paediatric ICU (75.6%) for sedation (67.2%). Conclusions Overall, most patients were treated with dexmedetomidine according to the product labelling. Use in children was limited but significant and similar in scope to that in adults. Administrations not fully according to the product labelling usually occurred in an ICU environment and reflected extensively investigated clinical uses of dexmedetomidine.
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Affiliation(s)
- Mary Weatherall
- Study Manager, Orion Pharma, PO Box 6792, Nottingham,, NG1 1AH, UK
| | - Riku Aantaa
- Perioperative Services, Intensive care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Giorgio Conti
- Anaesthesia and Intensive Care Medicine, Catholic University of Rome, Rome, Italy
| | - Chris Garratt
- Development Leader, Orion Pharma, PO Box 6792, Nottingham, NG1 1AH, UK
| | - Pasi Pohjanjousi
- Biostatistician, Orion Pharma, Volttikatu 8, P.O.Box 1780, 70701, Kuopio, Finland
| | - Michael A Lewis
- EPES Epidemiology GmbH, Wulffstr. 8, D-12165, Berlin, Germany
| | - Nicholas Moore
- Bordeaux Pharmacoepi, University of Bordeaux, 146 rue Léo Saignat ▪, 33076, Bordeaux cedex, France
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20
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Csomor J, Murínová I, Broulíková K, Kučerka O, Sedloň P, Jarošek J, Urbánek P, Zavoral M. Propofol-induced acute pancreatitis. J Clin Pharm Ther 2017; 42:495-498. [PMID: 28393377 DOI: 10.1111/jcpt.12524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/07/2017] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-induced acute pancreatitis comprises only 0.5%-2% of all cases of acute pancreatitis. Propofol is a potentially dangerous drug that can cause acute pancreatitis, but this complication is extremely rare. CASE SUMMARY A 57-year-old patient developed acute pancreatitis after a planned thyroidectomy. As the common causes of acute pancreatitis were excluded, we believe that the pancreatitis was drug-induced, in this case by a single dose of propofol administered to the patient during the surgery. WHAT IS NEW AND CONCLUSION We present a rare case of propofol-induced acute necrotising pancreatitis, which is to the best of our knowledge the first fatal case reported in an adult patient.
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Affiliation(s)
- J Csomor
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - I Murínová
- Department of Clinical Pharmacy, Military University Hospital Prague, Prague, Czech Republic.,Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - K Broulíková
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - O Kučerka
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - P Sedloň
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - J Jarošek
- Surgical Clinic, 2nd Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - P Urbánek
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - M Zavoral
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital Prague, Prague, Czech Republic
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21
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Kumar V, Garg R, Agarwal S, Madan K. Asystole during rigid bronchoscopic stenting under general anaesthesia in a patient with tracheo-oesophageal fistula. Indian J Anaesth 2017; 61:360-361. [PMID: 28515532 PMCID: PMC5416734 DOI: 10.4103/ija.ija_729_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Vinod Kumar, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shilpi Agarwal
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorder, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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22
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Kim KN, Lee HJ, Kim SY, Kim JY. Combined use of dexmedetomidine and propofol in monitored anesthesia care: a randomized controlled study. BMC Anesthesiol 2017; 17:34. [PMID: 28253863 PMCID: PMC5335826 DOI: 10.1186/s12871-017-0311-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/23/2017] [Indexed: 02/13/2023] Open
Abstract
Backgroud Although propofol and dexmedetomidine have been widely used for monitored anesthesia care, their adverse effects necessitate the search for better methods. Therefore, we performed this randomized controlled trial to evaluate the combined use of propofol and dexmedetomidine. Methods Eighty-seven adult patients undergoing hand surgery under brachial plexus block were randomly allocated to receive 1.6 μg/ml of the target effect site concentration of propofol (P group) and infusion of 0.4 μg/kg/h dexmedetomidine following a loading dose of 1.0 μg/kg for 10 min (D group). The M group received a half-dose of both drugs simultaneously. The maintenance dose was adjusted to maintain an Observer Assessment of Alertness/Sedation score of 3. Cardiorespiratory variables, adverse effects, and drug efficacy were observed. Results The significantly higher mean arterial pressure (mmHg) in the D group [P group 86.9 (12.6), D group 96.0 (12.2), M group 85.6 (10.6), p = 0.004)] and a significantly higher heart rate (beat/min) in the P group were observed [P group 67.3 (9.0), D group 57.8 (6.9), M group 59.2 (7.4), p < 0.001)]. The M group had a significant lower incidence of airway obstruction (p < 0.001) and the D group had a higher incidence of bradycardia requiring atropine (p = 0.001). The P group had higher incidences of hypoxia (p = 0.001), spontaneous movement (p < 0.001) and agitation (p = 0.001). The satisfaction scores of the patients (p = 0.007) and surgeon (p < 0.001) were higher in the M group. Onset time was significantly longer in the D group (p < 0.001). Conclusions The combined use of propofol and dexmedetomidine provided cardiovascular stability with decreased adverse effects. Additionally, it led to a similar onset time of propofol and achieved higher satisfaction scores. Trial registration KCT0001284. Retrospectively registered 25 November 2014.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
| | - Hee Jong Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea.
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
| | - Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
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23
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He L, Xu JM, Liu SM, Chen ZJ, Li X, Zhu R. Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia. Biol Pharm Bull 2017; 40:169-173. [PMID: 28154256 DOI: 10.1248/bpb.b16-00651] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient, which may also cause adverse effects. In this prospective, randomized, double-blind, placebo-controlled study, we sought to evaluate the effect of intrathecal dexmedetomidine, administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery, on the incidence and severity of shivering associated with spinal anesthesia. Patients undergoing Cesarean delivery were randomly allocated to three groups of 30 patients each. Experimental treatments were added to hyperbaric bupivacaine as follows: Patients in group I (control) were administered isotonic saline. Patients in groups II and III received dexmedetomidine (2.5, 5 µg, respectively), mixed with isotonic saline. Shivering was observed in 11, 10 and 2 patients in groups I, II and III, respectively. The incidence of shivering in group III was significantly lower than that in groups I (p=0.005) and II (p=0.01). The severity of shivering was significantly different between the three groups (p=0.01). There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia (p>0.05). Intrathecal dexmedetomidine (5 µg) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia.
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Affiliation(s)
- Liang He
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University
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24
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Nishizawa T, Suzuki H, Hosoe N, Ogata H, Kanai T, Yahagi N. Dexmedetomidine vs propofol for gastrointestinal endoscopy: A meta-analysis. United European Gastroenterol J 2017; 5:1037-1045. [PMID: 29163971 DOI: 10.1177/2050640616688140] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background and aim Several randomized controlled trials have compared sedation with dexmedetomidine and propofol in gastrointestinal endoscopy, with contradictory results. We conducted a meta-analysis of data from randomized controlled trials that compared dexmedetomidine with propofol. Methods We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database for randomized trials eligible for inclusion in our meta-analysis. We identified six eligible randomized trials from the database search, and compared the effect of propofol versus dexmedetomidine with respect to: (a) patient's satisfaction level, (b) body movement or gagging, (c) cardiopulmonary complications, and (d) change in heart rate. Data from eligible studies were combined to calculate pooled risk difference (RD) or weighted mean difference (WMD). Results Compared to propofol, dexmedetomidine significantly decreased the patient's satisfaction level (WMD: -0.678, 95% confidence interval (CI): -1.149 to -0.207, p = 0.0048), and there was no significant heterogeneity among the trial results. The pooled RD for developing body movement or gagging when using dexmedetomidine was 0.107 (95% CI: -0.09 to 0.305, p = 0.288), with no significant differences. Compared with propofol, the pooled RD for hypotension, hypoxia, and bradycardia with dexmedetomidine sedation were -0.029 (95% CI: -0.11 to 0.05), -0.080 (95% CI: -0.178 to 0.018), and 0.022 (95% CI: -0.027 to 0.07), respectively, with no significant differences. Compared to propofol, dexmedetomidine significantly decreased the heart rate (WMD: -10.41, 95% CI: -13.77 to -7.051, p ≤ 0.0001), without significant heterogeneity. Conclusions In gastrointestinal endoscopy, patient satisfaction level was higher in propofol administration, when compared to dexmedetomidine. The risk of complications was similar.
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Affiliation(s)
- Toshihiro Nishizawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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25
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Borg L, Walters TL, Siegel LC, Dazols J, Mariano ER. Use of a home positive airway pressure device during intraoperative monitored anesthesia care for outpatient surgery. J Anesth 2016; 30:707-10. [PMID: 27169990 DOI: 10.1007/s00540-016-2188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
Perioperative positive airway pressure (PAP) is recommended by the American Society of Anesthesiologists for patients with obstructive sleep apnea, but a readily available and personalized intraoperative delivery system does not exist. We present the successful use of a patient's own nasal PAP machine in the operating room during outpatient foot surgery which required addition of a straight adaptor for oxygen delivery and careful positioning of the gas sampling line to permit end-tidal carbox dioxide monitoring. Home PAP machines may provide a potential alternative to more invasive methods of airway management for patients with obstructive sleep apnea under moderate sedation.
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Affiliation(s)
- Lindsay Borg
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Tessa L Walters
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - Lawrence C Siegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - John Dazols
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. .,Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA.
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26
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Amornyotin S. Dexmedetomidine in gastrointestinal endoscopic procedures. World J Anesthesiol 2016; 5:1-14. [DOI: 10.5313/wja.v5.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/07/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal endoscopy is the gold standard in the examination and the treatment of the diseases of gastrointestinal system, but the disadvantage of being painful process. At this point the sedative and analgesic agents may be important. Dexmedetomidine is a new sedoanalgesic agent which is alternative to benzodiazepines and opioids. It has analgesia, amnesia, sedative and anxiolytic properties. The use of dexmedetomidine as the sole anesthetic agent and as the adjuvant analgesic agent has been published but has not been approved because of the inconsistency of efficacy and safety. The author has been collected the published papers in the literature. This article is aimed to describe the use of dexmedetomidine in various gastrointestinal endoscopic procedures.
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