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Chapter 9
ABSTRACT
Background
: Dexmedetomidine possesses anxiolytic and hypnotic properties without
respiratory side effects, making it theoretically an ideal sedative agent for endoscopic
procedures.
Objective
: We aimed to compare satisfaction and safety among outpatients receiving
sedation with dexmedetomidine or propofol for endoscopic oesophageal procedures.
Design:
A randomised controlled study.
Setting:
Endoscopic intervention suite at the Academic Medical Centre in Amsterdam, the
Netherlands.
Participants:
Patients aged at least 18 years, and American Society of Anesthesiologists’
physical status 1 to 3.
Intervention:
Total 63 patients were randomised to receive either dexmedetomidine (D) or
propofol (P). Pain was treated with alfentanil in both groups.
Main Outcome Measures:
The primary outcome was patients’ and endoscopists’ satisfaction
levels measured by validated questionnaires (1 = very dissatisfied; 7 = highly satisfied).
Secondary outcome was safety determined by blood pressure, heart rate and oxygen
saturation during and after the procedure, respiratory rate and non-invasive cardiac output
during the procedure.
Results:
Satisfaction of patients [median (IQR); group D, 5.0 (3.75 to 5.75) vs. group P, 6.25
(5.3 to 6.5)] and satisfaction of gastroenterologists [group D, 5.0 (4.4 to 5.8) vs. group P,
6.0 (5.4 to 6.0)] were lower in group D (both p<0.001). More patients in group D would
not recommend this form of sedation to one of their friends (group D, 15 of 32 vs. group
P, 1 of 31; p<0.001). Total 30 min after the procedure, heart rate [group D, 60 bpm (52 to
69) vs. group P, 70 bpm (60 to 81), p<0.031] and SBP group D, 112 mmHg (92 to 132) vs.
group P, 120 mmHg (108 to 132); p<0.013] were significantly lower after dexmedetomidine
sedation. There were no other differences in safety between groups.
Conclusion:
Sedation with dexmedetomidine caused less satisfaction than did propofol, and
caused prolonged haemodynamic depression after endoscopic oesophageal procedures.