Susanne Eberl

113

SATISFACTION AND SAFETY USING DEXMEDETOMIDINE OR PROPOFOL SEDATION

INTRODUCTION

Dexmedetomidine is a short-acting selective post-synaptic α

-agonists with anxiolytic

and hypnotic properties.

1,2

Patients receiving dexmedetomidine seem to be in a hypnotic

state but are easily arousable by verbal or tactile stimuli. Dexmedetomidine also decreases

requirements for other anaesthetics and analgesics and provides a diminished sympathetic

response to stress, leading finally to haemodynamic stability with no clinically important

respiratory side effects. However, sympatholysis can cause hypotension and bradycardia.

Dexmedetomidine seems to be an alternative option for sedation during endoscopic

outpatient procedures.

Propofol is a powerful sedative that has gained the role as the ‘gold standard’ for moderate

to deep procedural sedation because of its rapid onset and termination of action, and

the high level of satisfaction achieved among patients and gastroenterologists. Its most

important disadvantage is the risk of a rapid change from conscious to deep sedation with

the possibility of respiratory depression or airway obstruction leading to hypoxaemia and

cardiovascular depression.

3,4

Several trials have compared dexmedetomidine sedation with propofol in various

procedures with contradictory results.

5,6

No study has previously investigated these two

drugs in the setting of endoscopic oesophageal procedures under conscious sedation. The

primary aim of the current study was to estimate satisfaction of patients and endoscopists

associated with endoscopic oesophageal procedures conducted during sedation with

dexmedetomidine or propofol. As a secondary outcome, we estimated safety of sedation

with regard to haemodynamic and respiratory effects.

METHODS

Ethical approval was obtained from the Medical Ethics Committee of the Academic Medical

Centre (AMC), Amsterdam, the Netherlands (Chairperson Dr. M. Trip) (NL36861.018.11) on

12 January 2012.

All authors had access to the study data and reviewed and approved the final article.

A randomised controlled trial was performed. In the AMC, endoscopic oesophageal

procedures are routinely performed by two experienced endoscopists on Mondays and

Fridays in one intervention suite at the Department of Gastroenterology and Hepatology.

During the period between July 2012 and August 2013, all included patients were submitted

to either dexmedetomidine or propofol sedation 1:1 by random computer selection. The

study flow chart is shown in Figure 1.