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121

SATISFACTION AND SAFETY USING DEXMEDETOMIDINE OR PROPOFOL SEDATION

9

Other studies have compared dexmedetomidine with midazolam during procedural

sedation for colonoscopy and upper gastrointestinal endoscopy; dexmedetomidine was

shown to be superior to midazolamwith respect of endoscopists’ satisfaction and similar to

midazolamwith respect of endoscopists’ satisfaction and similar to midazolamwith respect

of patients` satisfaction.

12,13

In contrast to the current study, satisfaction with sedation during

the procedure was assessed in these studies, but not during the recovery period.

Arain and Ebert

14

found a prolonged sedative effect after intraoperative use of

dexmedetomidine compared with propofol among elective surgical patients. However,

this hangover of sedation was not identified as a satisfaction problem because patients

were not mobilised on the first postoperative day.

In our study, HR was lower during and after the endoscopic procedure with

dexmedetomidine compared with propofol, and three patients in group D suffered

syncope with severe bradycardia and unrecordable BP in the post-procedure period. BP was

significantly different only during the recovery period. Two reasons might be responsible.

First, propofol has a short elimination half- time leading to very short-lasting side effects.

Second, we hydrated patients prophylactically with 500 ml of 0.9% saline before starting the

procedure. Pre-hydration was intended to compensate for the pre-procedural fluid deficit

and vasodilatation caused by sedation, but might be too short lasting considering the

pharmacokinetic profile of dexmedetomidine with an infusion time-dependent context-

sensitive half-life. This haemodynamic pattern of a decreased HR, CO, and SV even after

termination of a prolonged (longer than 10 min) continuous infusion of dexmedetomidine

has been described previously in the literature.

15, 16

Jalowiecki et al.

17

even had to stop

prematurely a previous study during colonoscopies because of severe bradycardia. Ebert et

al.

16

concluded that cumulative cardiovascular effects of dexmedetomidine might limit its

usefulness in less healthy populations, suggesting that these effects can aggravate patients

with cardiovascular comorbidity in an unpredictable manner.

Takimoto et al.

6

compared dexmedetomidine with propofol and midazolam for sedation

in 90 patients during endoscopic submucosal dissection of gastric cancer and found

dexmedetomidine to be safe and effective. Compared with our study that applied extensive

haemodynamic and respiratory monitoring, only NIBP, ECG, and SpO

2

were monitored

at intervals of 10 min during the procedure. Furthermore, haemodynamic data on post-

procedural recovery were not assessed.

In our study, all episodes of syncope occurred in patients declared ready for discharge with

the modified Aldrete score equal or > 9. This scoring system does not include HR; therefore,

the modified Aldrete score is probably not the ideal discharge tool for patients treated with

dexmedetomidine.

There is no universal definition of patient satisfaction. Pascoe defined patient satisfaction as

the patient’s reaction consisting of a ‘cognitive evaluation’ and ‘emotional response’ to the