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Dexmedetomidine as a sole sedative agent versus propofol for sedation during upper and lower gastrointestinal endoscopies

Author: 
Alaa Ali M. Elzohry, Adnan Ahmed M. Ali, Wael Abd Elgwad Elsewify, Mohamed A. Ali Abozaid and Waleed Attia Hassan
Subject Area: 
Health Sciences
Abstract: 

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 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 1 µg/kg) followed by infusion of (dexmedetomidine 0.8 µg/kg /h). Propofol group; sedation was initially started by bolus dose of 0.5 mg/kg propofol IV Then, infusion was started at the rate of 50 µg /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 hemodynamic parameters (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 scores and other complications as arrhythmia and air way obstruction were increased in Propofol group (P. value 0.005*) in contrary to nausea, and vomiting that significantly decreased in Propofol group when compared to Dex 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; 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 as dexmedetomidine resulted in rapid onset and recovery, with sufficient levels of sedation and analgesia although occurrence of side effects as bradychardia and hypotension which were not serious and controllable.

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