A Comparison of the Sedative Effect of Dexmedetomidine and Midazolam on Patients Undergoing Gastrointestinal Endosonography Outside the Operating Room

Background: Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs. Objectives: This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room. Methods: This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 μg/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 μg/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 μg/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient. Results: The dexmedetomidine group had significantly higher SpO2 and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups. Conclusions: Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

[1]  Sholeh Nesioonpour,et al.  A comparison between the effects of propofol–fentanyl with propofol–ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room , 2016, Biomedical journal.

[2]  Wen-hua Chen,et al.  Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy , 2014, The Journal of international medical research.

[3]  Somchai Amornyotin..  Sedation and monitoring for gastrointestinal endoscopy. , 2013, World journal of gastrointestinal endoscopy.

[4]  L. Filik,et al.  Is topical pharyngeal anesthesia necessary in esophagogastroduodenoscopy in all unsedated patients? , 2013, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[5]  P. Garg,et al.  Safety and acceptance of non-sedated upper gastrointestinal endoscopy: a prospective observational study. , 2012, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[6]  M. Kollef,et al.  Occurrence and Predictors of Dexmedetomidine Infusion Intolerance and Failure , 2012, Hospital practice.

[7]  T. Nowicki,et al.  Procedural sedation and analgesia in the emergency department , 2011, Current opinion in critical care.

[8]  G. Turker,et al.  Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. , 2011, The Eurasian journal of medicine.

[9]  S. Ozkan,et al.  A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation , 2010, European journal of anaesthesiology.

[10]  E. Ely,et al.  Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. , 2009, JAMA.

[11]  Michelle A. Anderson,et al.  Sedation and anesthesia in GI endoscopy. , 2008, Gastrointestinal endoscopy.

[12]  M. Campbell,et al.  Use of dexmedetomidine for sedation of children hospitalized in the intensive care unit. , 2008, Journal of hospital medicine.

[13]  A. But,et al.  Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty , 2007, European journal of anaesthesiology.

[14]  A. Esmaoğlu,et al.  Comparison of propofol with propofol-ketamine combination in pediatric patients undergoing auditory brainstem response testing. , 2005, International journal of pediatric otorhinolaryngology.

[15]  A. Riphaus,et al.  Sedation with Propofol for Routine ERCP in High-Risk Octogenarians: A Randomized, Controlled Study , 2005, The American Journal of Gastroenterology.

[16]  Jun Lu,et al.  The &agr;2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects , 2003, Anesthesiology.

[17]  M. Brede,et al.  Physiological significance of alpha(2)-adrenergic receptor subtype diversity: one receptor is not enough. , 2002, American journal of physiology. Regulatory, integrative and comparative physiology.

[18]  M. Welte,et al.  Bispectral index-guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo-controlled phase II study* , 2002, Critical care medicine.

[19]  Judith E. Hall,et al.  The Effects of Increasing Plasma Concentrations of Dexmedetomidine in Humans , 2000, Anesthesiology.

[20]  M. Singer,et al.  Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit , 1999, Anaesthesia.

[21]  W. Hoffman,et al.  Heart rate variability and plasma catecholamines in patients during opioid detoxification. , 1999, Journal of neurosurgical anesthesiology.

[22]  Ronald M. Jones,et al.  Alpha‐2 and imidazoline receptor agonistsTheir pharmacology and therapeutic role , 1999, Anaesthesia.

[23]  M. Maze,et al.  The Pharmacokinetics and Hemodynamic Effects of Intravenous and Intramuscular Dexmedetomidine Hydrochloride in Adult Human Volunteers , 1993, Anesthesiology.

[24]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. , 1992, Anesthesiology.

[25]  Mervyn Maze,et al.  A Hypnotic Response to Dexmedetomidine, an α2 Agonist, Is Mediated in the Locus Coerüleus in Rats , 1992 .

[26]  T. Ishikawa,et al.  Binding of [3H]p-aminoclonidine to two sites, α2-adrenoceptors and imidazoline binding sites: distribution of imidazoline binding sites in rat brain , 1990, Brain Research.

[27]  J. Savola,et al.  Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. , 1988, European journal of pharmacology.

[28]  Ke Peng,et al.  Dexmedetomidine-fentanyl Compared With Midazolam-fentanyl for Conscious Sedation in Patients Undergoing Lumbar Disc Surgery. , 2016, Clinical therapeutics.

[29]  Devangi A. Parikh,et al.  A prospective randomized double blind study to compare dexmedetomidine and midazolam in ear nose and throat surgery for monitored anesthesia care , 2016 .

[30]  N. Gupta,et al.  Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial , 2014, Indian journal of anaesthesia.

[31]  Zhao Huang,et al.  Dexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure. , 2012, Internal medicine.

[32]  M. Roizen.  Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial , 2010 .

[33]  M. T. Gilani,et al.  COMPARISION OF RECOVERY TIME AND COMPLICATIONS IN GENERAL ANESTHESIA WITH REMIFENTANYL AND PROPOFOL AND TOPICAL ANESTHESIA WITH CONSCIOUS SEDATION IN NON –COMPLICATED CATARACT PHACO SURGERY , 2008 .

[34]  A. Tamer,et al.  The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. , 2007, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[35]  M. Maze,et al.  A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. , 1992, Anesthesiology.