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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