Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425

doi: 10.1111/jcpt.12282

A comparison of propofol vs. dexmedetomidine for sedation, haemodynamic control and satisfaction, during esophagogastroduodenoscopy under conscious sedation Y. Wu* MD, Y. Zhang* MD PhD, X. Hu* MD PhD, C. Qian† MD, Y. Zhou† MD and J. Xie† RN *Department of Anaesthesiology, the Second Hospital of Anhui Medical University, Hefei, and †Department of Endoscopy, the Second Hospital of Anhui Medical University, Hefei, China

Received 27 December 2014, Accepted 15 April 2015

Keywords: conscious sedation, dexmedetomidine, endoscopy, propofol

SUMMARY

WHAT IS KNOWN AND OBJECTIVE

What is known and objective: Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure which requires sedation for most patients. We undertook a prospective, randomized, double-blinded study to compare the effect of propofol vs. dexmedetomidine on the sedation of outpatients during EGD. Methods: Prior to the procedure, outpatients received either propofol at 0
6 mg/kg, with additional doses of 10–20 mg until the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) score reached 2–4, or dexmedetomidine at a loading dose of 1 lg/kg over a 10-min period followed by a 0
5 lg/kg/h infusion until the OAA/S score reached 2–4. Vital signs, sedation level, adverse events, patients’ and endoscopist’s satisfaction score, and an evaluation of the recovery time were assessed. Results and discussion: Negligible haemoglobin oxygen saturation (SpO2) and respiratory rate variations were observed in both groups, although respiratory depression occurred in two cases (5
9%) in the propofol group. Mean arterial pressure (MAP) in the propofol group decreased during the procedure compared with baseline (P < 0
05) and was also lower in comparison with the dexmedetomidine group (P < 0
05). Heart rate (HR) decreased after the loading dose in the dexmedetomidine group (P < 0
05). More patients in the propofol group underwent deeper sedation at the beginning of the procedure (P < 0
05), although the recovery time was comparable between the two groups (P > 0
05). Three cases (9
1%) in the dexmedetomidine group were delayed because of dizziness, bradycardia and nausea. There was a higher satisfaction score among patients in the propofol group (P < 0
05), although the endoscopist’s satisfaction score was comparable between the two groups (P > 0
05). What is new and conclusion: Propofol and dexmedetomidine provide a relatively satisfactory level of sedation without clinically notable adverse effects during EGD. In addition, patients preferred propofol administration for the deeper sedation and rapid recovery, and dexmedetomidine exhibited minimal adverse effects on respiratory function.

Esophagogastroduodenoscopy (EGD) is a commonly performed diagnostic and therapeutic procedure that requires measures to ensure the comfort of patients. This type of examination is unpleasant because of the gagging and nausea that is experienced during the procedure. Therefore, efficient sedation and analgesia must be achieved during the endoscopic procedure. Conscious sedation is routinely used in EGD primarily to minimize patient anxiety, discomfort and pain. Sedation enhances patient cooperation and facilitates the performance of the procedure by the endoscopists.1 However, a deeper level of sedation than intended is associated with a higher rate of complications, such as hypotension and respiratory depression.2–4 Therefore, the selection of an ideal sedative that provides amnesia, anxiolysis and analgesia with a wide margin of safety is essential. Propofol is a hypnotic agent that induces anaesthesia immediately, and patients recover rapidly after use. Therefore, this drug is commonly used in upper gastrointestinal endoscopy with or without opioids. However, propofol use is also associated with deep sedation2,5–7 that induces relevant complications, such as hypotension and respiratory depression. Dexmedetomidine is a highly selective a2-adrenoceptor agonist with sedative and analgesic effects.8 Dexmedetomidine provides conscious sedation with adequate analgesia and no respiratory depression.9 This drug also has a sympatholytic effect that attenuates stress responses to surgery and provides better haemodynamic stability.10 These beneficial effects make dexmedetomidine most suitable for conscious sedation.11–13 However, the sympatholytic effects of this drug may also cause adverse clinical effects, such as bradycardia.14 We compared the feasibility and safety of dexmedetomidine– fentanyl and propofol–fentanyl methods in conscious sedation for EGD. In particular, we compared the haemodynamics, respiration, level of sedation, recovery time and adverse effects between the two techniques. Questionnaires were also used to assess patient and endoscopist satisfactions. METHODS

Correspondence: Yun Wu, Department of Anaesthesiology, the Second Hospital of Anhui Medical University, NO. 678, Furong Road, Hefei, China. Tel: +86 138 6595 8254; fax: +86 551 63869483; e-mail: [email protected]

© 2015 John Wiley & Sons Ltd

Subjects The Ethics Committee of the Second Hospital of Anhui Medical University approved this study (KY201204), which complied with

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A comparison of propofol vs. dexmedetomidine

assistant or if the patient or endoscopist was uncomfortable, rescue intravenous sedation was provided with propofol in a top-up incremental dose of 20 mg until the patient reached an OAA/S score of 2–4. The number of patients requiring rescue propofol in each group was noted. As in the study of Gupta et al. and Sethi et al.,11,12 an independent observer blind to the medication used for sedation was in charge of patient monitoring, which included evaluating the level of consciousness and vital parameters and the collection of records, such as drugs and doses used, procedure duration (defined as the time from the introduction to the withdrawal of the endoscope) and adverse events of bradycardia (defined as HR under 50 beats/min or a 20% decrease from baseline), tachycardia (defined as HR over 110 beats/min or an increase of more than 20% from baseline), hypotension (defined as MAP lower than 60 mmHg or 20% less than baseline) and hypertension (defined as MAP over 150 mmHg or a 20% increase from baseline), which were treated accordingly. Respiratory depression (defined as respiratory rate of under 8 n/min or oxygen saturation under 90%) was also assessed, and a jaw thrust manoeuvre was applied to the patients if necessary.

the Helsinki Declaration. All patients provided written informed consent. This study prospectively included 70 patients between March and August 2014 from the Department of Endoscopy, the Second Hospital of Anhui Medical University. Patients of either sex, aged 18–65 years who underwent elective EGD procedure, with American Society of Anaesthesiologist (ASA) grades I or II, were included in this prospective, randomized, double-blinded trial. Randomization was conducted using a computer-generated randomization list created by a third party. The following exclusion criteria were used: ASA physical status grades III or higher; prior gastrectomy; comorbid conditions, such as diabetes mellitus, cardiovascular disease, or hepatic or renal insufficiency; history of chronic alcoholism; sedative or narcotic analgesic drug abuse; and allergy to any of the drugs or components, such as opioids, dexmedetomidine, egg or soya beans. Uncooperative and pregnant patients were also excluded. Patient monitoring Patients were taken into the endoscopy room without premedication. Vital parameters were monitored continuously using electrocardiography, non-invasive blood pressure and pulse oximetry. Mean arterial pressure (MAP), heart rate (HR), haemoglobin oxygen saturation (SpO2%) and respiration rate (RR) were recorded. We defined the following evaluation time points: baseline (T0); immediately before the procedure (T1); beginning of the procedure (T2); duodenum (T3) (approximately the midpoint of the procedure, when the endoscopist was evaluating the duodenum); and the end of the procedure (T4). Venous access was secured in the non-dominant hand of every patient using a 20-G cannula, and Ringer’s lactate drip (10 mL/kg/h) was started. All patients received prophylactic oxygen (4 L/min) via a face mask during the procedure. The same experienced endoscopist performed all EGD procedures using a video gastroscope (EG-2990K; Pentax Corp., Tokyo, Japan).

Recovery and satisfaction questionnaires The level of recovery from anaesthesia and the return of psychomotor fitness were studied using the Modified Post-anaesthesia Discharge Scoring System (MPADSS) scale (Table 1).17 The recovery score was assessed 15 min after removal of the endoscope and every 15 min thereafter until a discharge score of 9–10 was reached. The discharge criteria required that the patients were awake and alert with stable vital signs, able to ambulate with or without assistance, and free of side effects. Patient satisfaction at discharge was assessed with a 10-point visual analogue scale (1 = least satisfied and 10 = most satisfied). The visual analogue scale was also applied to the endoscopist who performed the procedures to assess their level of satisfaction, which was scored as follows: 1–3 = considerable difficulty in performing the procedure; 4–7 = minor difficulty in performing

Drug administration Patients were assigned to undergo conscious sedation with either propofol or dexmedetomidine using a computer-generated randomization schedule. Evaluations of the quality of sedation were based on a five-point Observer’s Assessment of Alertness/Sedation Scale (OAA/S),15 with scores of 1 for deep sedation, 2–4 for conscious sedation and 5 for mild sedation.16 Immediately before the procedure, patients in the propofol group (group P) received a bolus of 0
6 mg/kg propofol and additional 10–20 mg doses until the OAA/S scores reached 2–4. Patients in the dexmedetomidine group (group D) received dexmedetomidine at a loading dose of 1 lg/kg over 10 min followed by a 0
5 lg/kg/h infusion until the OAA/S scores reached 2–4. We chose these doses of propofol and dexmedetomidine to preserve sufficient consciousness to allow communication but provide the necessary degree of sedation to enable procedural comfort and an adequate quality of recovery with less adverse effects. A single dose of fentanyl 1 lg/kg was administered immediately before the procedure in all patients.

Table 1. Modified Post-Anaesthesia Discharge Scoring System* Category

Description

Score

Vital signs

Within 20% of preoperative value Within 20–40% of preoperative value Within 40% of preoperative value Steady gait/no dizziness With assistance None/dizziness Minimal Moderate Severe Minimal Moderate Severe Minimal Moderate Severe

2 1

Ambulation

Nausea/vomiting

Pain

Surgical bleeding

Management The OAA/S scores were recorded at the beginning of the procedure (T2) and duodenum (T3) in both groups. If a patient required more than three episodes of personal restraint by the

*See reference

© 2015 John Wiley & Sons Ltd

0 2 1 0 2 1 0 2 1 0 2 1 0

17.

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Y. Wu et al.

A comparison of propofol vs. dexmedetomidine the procedure; and 8–10 = no difficulty in performing the procedure.

Respiratory rate decreased at the beginning of the procedure in both groups (Fig. 2).

Statistical analysis

Sedation level

Continuous variables are expressed as means  SD, and means were compared between groups using Student’s t-test. Categorical variables are expressed as absolute numbers and percentages, which were compared using Pearson’s chi-square test or continuity correction and Fisher’s exact test where applicable. We used repeated measures analysis of variance to study the effects of the variable ‘group’ at the various time points. Statistical significance was assumed at the level of P < 0
05. Statistical analyses were performed using the SPSS software package (version 13.0, IBM SPSS Software, Armonk, NY, USA).

More patients achieved an OAA/S score of 4 in group D at the beginning of the procedure (63
6% in group D vs. 17
6% in group P, P = 0
000), and 76
5% patients in group P achieved a score of 3 compared with 36
4% in group D (P = 0
001). Two patients (5
9%) in group P reached a score of 2 compared with no patients in group D (5
9% in group P vs. 0
0% in group D, P = 0
493). The sedation level was comparable between the two groups at the time of duodenum examination, which was approximately the midpoint of the procedure (Figs 3 and 4). Procedure duration and satisfaction

RESULTS

The duration of the procedure was comparable between the two groups (P = 0
179), and there were no significant differences in the endoscopist’s satisfaction scores (P = 0
780). Patients’ satisfaction scores were higher in group P compared with group D (P = 0
010) (Table 3).

Patient characteristics Three patients were denied enrolment based on the exclusion criteria: one patient was aged < 18 years, and two patients had a history of hypertension. Sixty-seven patients participated. The randomization process assigned 33 patients to group D and 34 patients to group P (Fig. 1). There were no statistically significant differences in demographic data (Table 2) or baseline vital signs (Fig. 2) between the two groups. Endoscopy was completed in all patients. Mean arterial pressure in group P was lower than that in group D during the procedure, as well as compared with the baseline value. HR in group D decreased significantly after drug administration (P = 0
000) and after EGD (P = 0
024) compared with group P, and the HR value was an average 19
6% lower than baseline after drug administration in group D (P = 0
000). Negligible variations in SpO2 and respiratory rate were observed in both groups, although the respiratory rate decreased after propofol administration in group P (P = 0
008), which changed less after the loading dose of drug in group D compared with baseline.

Recovery The number of patients who recovered in the 15th minute was greater in group P than group D (94
1% in group P vs. 75
8% in group D, P = 0
077), but this difference did not reach statistical significance. There were no significant differences in the number of patients who recovered in the 30th minute between the two groups (15
2% in group P vs. 5
9% in group D, P = 0
401). Discharge was delayed in three patients in group D (0
0% in group P vs. 9
1% in group D, P = 0
227) because of the following factors at recovery: one case of bradycardia, one case of dizziness and nausea and one case of bradycardia and dizziness. Patients with bradycardia were treated with atropine (0
05 mg), and all three patients were treated with oxygen via a nasal catheter and intravenous fluid therapy during a 2-h observation period because of safety concerns (Fig. 5).

Fig. 1. Trial profile.

© 2015 John Wiley & Sons Ltd

Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425 421

Y. Wu et al.

A comparison of propofol vs. dexmedetomidine

current study found that both of these two sedatives provided a relatively satisfactory level of sedation without clinically notable adverse effects during EGD. Patients preferred propofol administration for the deeper sedation and rapid recovery, but propofol produced a significant decrease in MAP. Dexmedetomidine exhibited minimal adverse effects on respiratory function but was associated with bradycardia and sometimes led to a prolonged recovery time. The routine use of sedation during endoscopic procedures is increasing worldwide.18,19 Relatively healthy patients who undergo simple procedures, such as EGD or colonoscopy, often tolerate the procedure well with conscious sedation, which relieves anxiety, discomfort and pain without a loss of cardiovascular and ventilatory function.20 The results of this study indicate that patients tolerate the EGD procedure well under conscious sedation provided either by propofol or by dexmedetomidine associated with fentanyl. These findings compare favourably with those of prior studies by Sethi et al. and de la Morena et al.12,21 Sethi et al.12 demonstrated that dexmedetomidine was a superior alternative to midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP). In the study of de la Morena et al.21, the same dose of propofol provided moderate sedation, which was defined as a score of 3 on the OAA/S during the EGD procedure. However, the sedation level was deeper after propofol administration immediately before the procedure, and significantly more patients achieved an OAA/S score of 3. The therapeutic window of propofol is very narrow, which makes it easy to move from a moderate level of sedation to deep sedation.22 Propofol causes cardiac and respiratory depression in certain patients with a possible loss of airway reflexes in doses that are commonly used for moderate sedation.23 The current study confirmed that 5
9% of patients reached an OAA/S score of 2, which approaches deep sedation, and MAP was more depressed in the propofol group during the procedure compared with the dexmedetomidine group. Respiratory rate also decreased after drug administration, and respiratory depression that required the application of a jaw thrust manoeuvre was observed in 5
9% of the cases. This study compared the safety and efficiency of dexmedetomidine and propofol. Blood pressure was more stable in the dexmedetomidine group, and no respiratory depression was observed. Respiratory rate changed less after the loading dose;

Table 2. Patient demographics Variable

Group D (n = 33)

Group P (n = 34)

P value

Sex Male Female Age (yr) Weight (kg) Height (m) BMI (kg/m2)

15 (45
5) 18 (54
5) 40
4  11
6 58
0  9
3 1
6  0.1 21
4  2
7

13 (38
2) 21 (61
8) 39
0  14
4 55
9  10
1 1
6  0
1 20
5  3
0

0
549 0
678 0
389 0
685 0
178

Data are expressed as absolute numbers (percentages) or means  SD. Group D = dexmedetomidine group; group P = propofol group; BMI = body mass index.

Complications Patients in group D showed a significantly higher incidence of gagging during the procedure compared with patients in group P (60
6% in group D vs. 20
6% in group P, P = 0
001) (Table 4). However, there were no significant differences in the number of patients requiring propofol (42
4% in group D vs. 32
4% in group P, P = 0
394) (Fig. 6). Bradycardia and respiratory depression were comparable between the two groups. Bradycardia was observed in four cases during the procedure and two cases at recovery in group D (18
2%) and one case during the procedure in group P (2
9%) (P = 0
101). Atropine (0
05 mg) was required in all of these cases. Respiratory depression occurred in two cases during the procedure in group P (5
9%), requiring a jaw thrust manoeuvre to be applied, and there was no respiratory depression in group D (P = 0
493). Two patients in group D experienced dizziness (6
1%), and one patient felt nausea (3
0%) at recovery, but neither of these adverse events occurred in group P (Table 4). DISCUSSION The authors compared the feasibility and safety of two sedatives, propofol and dexmedetomidine, for conscious sedation in outpatients scheduled for EGD, which was not reported previously. The

Fig. 2. Mean values of mean arterial pressure (MAP, in mmHg), heart rate (HR, in beats/min), respiratory rate (RR, in n/min), and haemoglobin oxygen saturation (SpO2, as a percentage) determined at different time points of the procedure. T0 = baseline; T1 = immediately before the procedure; T2 = beginning of the procedure; T3 = duodenum; T4 = end of the procedure. Group D = dexmedetomidine group; Group P = propofol group. Vertical lines represent SDs. *P < 0
05, compared between the two groups; §P < 0
05, compared within group D; #P < 0
05, compared within group P.

© 2015 John Wiley & Sons Ltd

Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425 422

Y. Wu et al.

A comparison of propofol vs. dexmedetomidine

Fig. 3. Level of sedation (Observer’s Assessment of Alertness/ Sedation score) immediately before the procedure. *P < 0
05, compared between the two groups.

Fig. 5. Number of patients’ achievement of Modified Post-anaesthesia Discharge Scoring System scale of 9–10 at 15 min, 30 min and exceeding 30 min.

Table 4. Adverse events

Fig. 4. Level of sedation (Observer’s Assessment of Alertness/ Sedation score) during examination of the duodenum.

Group D (n = 33)

Group P (n = 34)

P value

Duration of procedure (s) Patients’ satisfaction score Endoscopist’s satisfaction score

248
4  79
4 8
9  1
4 8
2  1
1

221
8  81
3 9
6  0
8 8
2  0
9

0
179 0
010 0
780

Group D (n = 33)

Group P (n = 34)

P value

Gagging Bradycardia Respiratory depression Dizziness Nausea

20 6 0 2 1

7 1 2 0 0

0
001 0
101 0
493 0
239 0
493

(60
6) (18
2) (0
0) (6
1) (3
0)

(20
6) (2
9) (5
9) (0
0) (0
0)

Data are expressed as absolute numbers (percentages). Group D = dexmedetomidine group; group P = propofol group.

Table 3. Duration of the procedure and the satisfaction score

Variable

Variable

Data are expressed as means  SD. Group D = dexmedetomidine group; group P = propofol group.

however, respiratory rate decreased at the beginning of the procedure which was likely induced by the supplemental propofol that patients required. A greater decrease in HR was observed after drug administration. Similar haemodynamic effects were observed in patients sedated with dexmedetomidine in the intensive care unit, which demonstrates that HR is significantly lower in dexmedetomidine-treated patients.24,25 Bradycardia is a major adverse effect of a2-agonist agents that is mediated by the activation of a2-adrenoceptors and imidazoline-preferring receptors in the ventrolateral medulla and solitarius nucleus tract.26,27 There were no significant differences in the incidence of bradycardia between the two groups, although patients with bradycardia after the procedure exhibited a slower recovery. These results suggest that bradycardia is more serious with dexmedetomidine use. One study from Poland compared dexmedetomidine with meperidine or fentanyl as a single agent for sedation during colonoscopy, and these investigators found that the dexmedetomidine group required significant supplemental fentanyl and had a higher risk of bradycardia and hypotension.28 Another report suggests that dexmedetomidine produces general anaesthesia when administered in high doses that are often associated with

Fig. 6. Number of patients requiring propofol. bradycardia, hypotension and prolonged recovery.29 These studies are somewhat comparable with the current study, and these adverse effects were the reason for the chosen dose of dexmedetomidine. The incidence of gagging in the current study was significantly higher in the dexmedetomidine group, and the number of patients requiring additional propofol was also greater in this group. However, there were no significant differences between the two groups. Sethi et al.12 demonstrated that the incidence of gagging during ERCP in patients sedated with dexmedetomidine was 23% using dose that was comparable with the current study, in which the incidence was 60
6%. The reason for this difference in gagging is not clear, although the ERCP patients received more supplemental propofol during the procedure, and the long duration of the ERCP increased the total dose of dexmedetomidine that

© 2015 John Wiley & Sons Ltd

Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425 423

Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425

doi: 10.1111/jcpt.12282

A comparison of propofol vs. dexmedetomidine for sedation, haemodynamic control and satisfaction, during esophagogastroduodenoscopy under conscious sedation Y. Wu* MD, Y. Zhang* MD PhD, X. Hu* MD PhD, C. Qian† MD, Y. Zhou† MD and J. Xie† RN *Department of Anaesthesiology, the Second Hospital of Anhui Medical University, Hefei, and †Department of Endoscopy, the Second Hospital of Anhui Medical University, Hefei, China

Received 27 December 2014, Accepted 15 April 2015

Keywords: conscious sedation, dexmedetomidine, endoscopy, propofol

SUMMARY

WHAT IS KNOWN AND OBJECTIVE

What is known and objective: Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure which requires sedation for most patients. We undertook a prospective, randomized, double-blinded study to compare the effect of propofol vs. dexmedetomidine on the sedation of outpatients during EGD. Methods: Prior to the procedure, outpatients received either propofol at 0
6 mg/kg, with additional doses of 10–20 mg until the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) score reached 2–4, or dexmedetomidine at a loading dose of 1 lg/kg over a 10-min period followed by a 0
5 lg/kg/h infusion until the OAA/S score reached 2–4. Vital signs, sedation level, adverse events, patients’ and endoscopist’s satisfaction score, and an evaluation of the recovery time were assessed. Results and discussion: Negligible haemoglobin oxygen saturation (SpO2) and respiratory rate variations were observed in both groups, although respiratory depression occurred in two cases (5
9%) in the propofol group. Mean arterial pressure (MAP) in the propofol group decreased during the procedure compared with baseline (P < 0
05) and was also lower in comparison with the dexmedetomidine group (P < 0
05). Heart rate (HR) decreased after the loading dose in the dexmedetomidine group (P < 0
05). More patients in the propofol group underwent deeper sedation at the beginning of the procedure (P < 0
05), although the recovery time was comparable between the two groups (P > 0
05). Three cases (9
1%) in the dexmedetomidine group were delayed because of dizziness, bradycardia and nausea. There was a higher satisfaction score among patients in the propofol group (P < 0
05), although the endoscopist’s satisfaction score was comparable between the two groups (P > 0
05). What is new and conclusion: Propofol and dexmedetomidine provide a relatively satisfactory level of sedation without clinically notable adverse effects during EGD. In addition, patients preferred propofol administration for the deeper sedation and rapid recovery, and dexmedetomidine exhibited minimal adverse effects on respiratory function.

Esophagogastroduodenoscopy (EGD) is a commonly performed diagnostic and therapeutic procedure that requires measures to ensure the comfort of patients. This type of examination is unpleasant because of the gagging and nausea that is experienced during the procedure. Therefore, efficient sedation and analgesia must be achieved during the endoscopic procedure. Conscious sedation is routinely used in EGD primarily to minimize patient anxiety, discomfort and pain. Sedation enhances patient cooperation and facilitates the performance of the procedure by the endoscopists.1 However, a deeper level of sedation than intended is associated with a higher rate of complications, such as hypotension and respiratory depression.2–4 Therefore, the selection of an ideal sedative that provides amnesia, anxiolysis and analgesia with a wide margin of safety is essential. Propofol is a hypnotic agent that induces anaesthesia immediately, and patients recover rapidly after use. Therefore, this drug is commonly used in upper gastrointestinal endoscopy with or without opioids. However, propofol use is also associated with deep sedation2,5–7 that induces relevant complications, such as hypotension and respiratory depression. Dexmedetomidine is a highly selective a2-adrenoceptor agonist with sedative and analgesic effects.8 Dexmedetomidine provides conscious sedation with adequate analgesia and no respiratory depression.9 This drug also has a sympatholytic effect that attenuates stress responses to surgery and provides better haemodynamic stability.10 These beneficial effects make dexmedetomidine most suitable for conscious sedation.11–13 However, the sympatholytic effects of this drug may also cause adverse clinical effects, such as bradycardia.14 We compared the feasibility and safety of dexmedetomidine– fentanyl and propofol–fentanyl methods in conscious sedation for EGD. In particular, we compared the haemodynamics, respiration, level of sedation, recovery time and adverse effects between the two techniques. Questionnaires were also used to assess patient and endoscopist satisfactions. METHODS

Correspondence: Yun Wu, Department of Anaesthesiology, the Second Hospital of Anhui Medical University, NO. 678, Furong Road, Hefei, China. Tel: +86 138 6595 8254; fax: +86 551 63869483; e-mail: [email protected]

© 2015 John Wiley & Sons Ltd

Subjects The Ethics Committee of the Second Hospital of Anhui Medical University approved this study (KY201204), which complied with

419

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A comparison of propofol vs. dexmedetomidine

18. Igea F, Casellas JA, Gonz
alez-Huix F et al. Sedation for gastrointestinal endoscopy. Clinical practice guidelines of the Sociedad Espa~ nola de Endoscopia Digestiva. Rev Esp Enferm Dig, 2014;106:195–211. 19. Watkins TJ, Bonds RL, Hodges K, Goettle BB, Dobson DA, Maye JP. Evaluation of postprocedure cognitive function using 3 distinct standard sedation regimens for endoscopic procedures. AANA J, 2014;82: 133–139. 20. Ozel AM, Onc€ u K, Yazgan Y, G€ urb€ uz AK, Demirt€ urk L. Comparison of the effects of intravenous midazolam alone and in combination with meperidine on hemodynamic and respiratory responses and on patient compliance during upper gastrointestinal endoscopy: a randomized, double-blind trial. Turk J Gastroenterol, 2008; 19:8–13. 21. de la Morena F, Santander C, Esteban C, de Cuenca B, Garc
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cal anesthesia. Anesthesiology, 1991;74:581– 605. Kuhar MJ, Unnerstall JR. Mapping receptors for alpha 2-agonists in the central nervous system. J Cardiovasc Pharmacol, 1984;6(Suppl 3):S536–S542. 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;103:269– 273. Ramsay MA, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology, 2004;101:787–790. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs, 2000;59:263–268. Discussion 2000; 269–270. Kim WH, Cho YJ, Park JY, Min PK, Kang JK, Park IS. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc, 2000;52:600– 605.

Journal of Clinical Pharmacy and Therapeutics, 2015, 40, 419–425 425