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Satisfaction and safety using dexmedetomidine or propofol sedation during endoscopic oesophageal procedures: A

Susanne Eberl¹, Benedikt Preckel, Jacques J Bergman

¹From the Department of Anaesthesiology (SE, BP, MWH), Department of Gastroenterology & Hepatology (JJB), and Clinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (SVD).

European Journal of Anaesthesiology

|March 8, 2016

Abstract

Background:

Dexmedetomidine possesses anxiolytic and hypnotic properties without respiratory side-effects, making it theoretically an ideal sedative agent for endoscopic procedures.

Objective:

We aimed to compare satisfaction and safety among outpatients receiving sedation with dexmedetomidine or propofol for endoscopic oesophageal procedures.

Design:

A randomised controlled study.

Setting:

Endoscopic intervention suite at the Academic Medical Centre in Amsterdam, Netherlands.

Participants:

Patients aged at least 18 years, and American Society of Anesthesiologists' physical status 1 to 3.

Intervention:

Total 63 patients were randomised to receive either dexmedetomidine (D) or propofol (P). Pain was treated with alfentanil in both groups.

Main Outcome Measures:

The primary outcomes were patients' and endoscopists' satisfaction levels measured by validated questionnaires (1 = very dissatisfied; 7 = highly satisfied). A secondary outcome was safety, determined by blood pressure, heart rate and oxygen saturation during and after the procedure, and respiratory rate and noninvasive cardiac output during the procedure.

Results:

Satisfaction of patients [median (IQR); group D, 5.0 (3.75 to 5.75) vs. group P, 6.25 (5.3 to 6.5)] and satisfaction of gastroenterologists [group D, 5.0 (4.4 to 5.8) vs. group P, 6.0 (5.4 to 6.0)] were lower in group D (both P < 0.001). More patients in group D would not recommend this form of sedation to one of their friends (group D, 15 of 32 vs. group P, 1 of 31; P < 0.001). Total 30 min after the procedure, heart rate [group D, 60 bpm (52 to 69) vs. group P, 70 bpm (60 to 81), P = 0.031] and SBP group D, 112 mmHg (92 to 132) vs. group P, 120 mmHg (108 to 132); P = 0.013] were significantly lower after dexmedetomidine sedation. There were no other differences in safety between groups.

Conclusion:

Compared with propofol, sedation with dexmedetomidine resulted in less satisfaction, and caused prolonged haemodynamic depression after endoscopic oesophageal procedures.

Trial Registration:

ISRCTN Register (ISRCTN 68599804).

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