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ENGLISH SUMMARY
Therefore, the expectations of dexmedetomidine to be an ideal medication for moderate
sedationhadbeenhigh. Unfortunately, dexmedetomidine couldnot fulfil theseexpectations
in our randomised trail.
Dexmedetomidine combined with alfentanil was less satisfying and less safe compared to
propofol-alfentanil in patients undergoing endoscopic oesophageal procedures. Global
satisfaction among patients and gastroenterologists was significantly lower if patients were
treated with dexmedetomidine. Main negative points for endoscopists were a rather slow
onset of action and prolonged recovery combined with an inadequate level of sedation -
making the endoscopic procedure more difficult. 30 of 31 patients in the dexmedetomidine
group even needed additional propofol to tolerate the procedure at all.
For the patients, the most problematic point was a spill over of post-sedation side effects -
like drowsiness and grogginess - after termination of the procedure, restraining resuming
of daily life activities. Therefore, they decisively denied the question whether they would
suggest this form of sedation to one of their friends.
Considering safety, patients sedated with dexmedetomidine had significantly lower values
of HR and NIBP during the recovery period. Three patients even suffered serious syncopes
with serious bradycardia (25, 27 and 35 bpm) and unrecordable NIBP between 75 and 90
min after the procedure (and actually declared ready to discharge). Jalowiecki et al.
36
even
had to prematurely stop a
study investigating dexmedetomidine during colonoscopies
because of severe bradycardia. Ebert et al.
37
concluded that cumulative cardiovascular
effects of dexmedetomidine might limit its usefulness in less healthy populations,
suggesting that these effects can aggravate in patients with cardiovascular comorbidities in
an unpredictable manner. Therefore, we had to conclude that dexmedetomidine was not
able to banish propofol from its first place on the sedation drugs ranking list for procedural
sedation.
Chapter 10
investigated the suitability of remifentanil for moderate sedation during
bronchial thermoplasty (BT) in high-risk severe asthma patients.
38
In this trial we were able to
show that remifentanil sedation combined with propofol and local installation of lidocaine
is safe and feasible with high satisfaction rates for both, patients and bronchoscopists.
Themajority of patients weremoderate sedatedwith an OAA/S score between 3 and 4, were
able to open their eyes when called loudly, and responded to assignments. Patients showed
a median VAS score of overall satisfaction of 9.6 (interquartile range [IQR] 8.5–10.0). This
conformed to bronchoscopists’ median VAS scores of overall patient cooperation of 9.1 (IQR
8.5–9.6). All patients were willing to undergo the procedure again and would recommend
this form of sedation to their best friend. One case of conversion to general anaesthesia
occurred, but no other serious adverse events were reported. A quality parameter for BTs is
the number of electrical activations that can be performed on the bronchial system during