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SATISFACTION AND SAFETY USING DEXMEDETOMIDINE OR PROPOFOL SEDATION
9
Endoscopic procedure and monitoring
No premedication was provided. An intravenous cannula was inserted, and 500 ml of 0.9%
saline was infused, followed by administration of glycopyrolate 0.2 mg and lignocaine 50
mg. Five minutes before insertion of the endoscope, the pharynx was sprayed with 10%
lignocaine spray (Xylocaine 10%, Astra, the Netherlands).
During the procedure, oxygen was administered by nasal cannula at a flow rate of 2 l/min
and patients were constantly monitored for HR, oxygen saturation (SpO
2
), ECG and exhaled
carbon dioxide concentration, and non-invasive blood pressure (NIBP) were measured
at 5-min intervals. Non-invasive cardiac output (NICO) was measured continuously using
Nexfin technology (Edwards Lifesciences, Irvine, California, USA), and stroke volume (SV)
and systemic vascular resistance (SVR) were estimated. The Nexfin system provides beat-to-
beat, continuous NIBP by measuring finger arterial pressure with a small cuff, thus without
the need for arterial cannulation. The resulting blood pressure (BP) waveform is used as the
basis for the estimation of continuous NICO.
After the procedure, monitoring during recovery was limited to SpO
2
, ECG and NIBP.
Recovery from anaesthesia and the return of psychomotor fitness were assessed using
the modified Aldrete Score
8
on arrival in the recovery room and 30 and 60 min after
termination of the endoscopic procedure. This score is designed to assess patient recovery
and describes the patient’s motor activity, mechanical respiratory function, SpO
2
, BP, and
consciousness. The total score is 10. Patients had to stay for at least 2 h in the recovery
room although virtually ‘ready for discharge’ was declared when an Aldrete Score at least 9
or similar to the preprocedural score was achieved. Patients had to be capable of walking
without assistance before discharge.
Sedative intervention
Special sedation anaesthesia nurses (with an anaesthesiologist as back-up) were responsible
for sedation. Patients in group D were treated with dexmedetomidine (Dexdor: Orion
corporation, Finland). Owing to the absence of precise pharmacokinetic/pharmacodynamic
models for a dexmedetomidine target controlled infusion (TCI) system, we used the dosage
recommended by the Food and Drug Administration for bolus and continuous sedation
with dexmedetomidine. We started with a loading dose of 1 mg/kg of dexmedetomidine
intravenously over 10 min followed by a maintenance rate of 0.7 to 1 mg/kg/h continued
throughout the procedure. In patients aged more than 65 years, the loading dose was
reduced to 0.5 mg/kg.
5
Patients in group P received the routine AMC sedation regimen
using a propofol TCI system (Propofol 1%MCT Fresenius, Germany), starting with a targeted
plasma concentration of 2.0 mg/ml.
Before the endoscopic procedure started, patients were assessed for level of sedation using
theobserver’s assessment of alertness/sedation scale (OAA/S) yieldinga scorebetween2 and