CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2014; 05(02): 051-057
DOI: 10.4103/0976-5042.144826
Original Article
Society of Gastrointestinal Endoscopy of India

Comparison of dexmedetomidine, midazolam, and propofol as an optimal sedative for upper gastrointestinal endoscopy: A randomized controlled trial

Sumanth Samson
Departments of Anesthesiology, Pondicherry Institute of Medical Sciences, Puducherry, India
,
Sagiev Koshy George
Departments of Anesthesiology, Pondicherry Institute of Medical Sciences, Puducherry, India
,
B. Vinoth
1   Department of Anesthesiology, Gastroenterology
,
Mohd Saif Khan
Departments of Anesthesiology, Pondicherry Institute of Medical Sciences, Puducherry, India
,
Bridgitte Akila
2   Department of Anesthesiology, Biostatistics, Pondicherry Institute of Medical Sciences, Puducherry, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

Abstract

Context: Midazolam and propofol are effective sedatives for use in upper gastrointestinal endoscopy (UGIE); however, their utility is limited when used alone. In this regard, dexmedetomidine seems to be a promising sedative. Aims: The aim was to compare the hemodynamic effects and sedation efficacy of these drugs in patients undergoing elective diagnostic UGIE. Settings and Design: Randomized control double-blind study was conducted at a teaching hospital. Subjects and Methods: Patients belonging to ASA Grade I or II, undergoing diagnostic elective UGIE were enrolled in the study and randomized into three groups; Group I received midazolam infusion, Group II received propofol infusion and Group III received dexmedetomidine infusion. Hemodynamic parameters and adverse events were recorded during the procedure (intra-operative period [IOP]). Both patient and endoscopist satisfaction were rated on visual analog scale (0 = no pain/least difficulty to 10 = worst pain/maximum difficulty). Recovery was recorded as time to achieve modified Aldrete score of 10/10. Statistical Analysis: Parametric test analysis of variance was applied to compare the means of three groups of continuous data. Results: Ninety patients were analyzed. Mean arterial pressure was significantly lower in the propofol group at IOP2, IOP4, IOP8, and IOP10 compared with dexmedetomidine and midazolam group. The endoscopist satisfaction level was significantly higher in dexmedetomidine group as compared to propofol and midazolam (60%, 56.7%, 13.3%; P < 0.001). Significantly faster recovery was observed in dexmedetomidine group compared to midazolam and propofol group (7.7 ± 3.9, 18.3 ± 3.8, 12.7 ± 2.9 min; P = 0.001). Conclusions: Use of dexmedetomidine was associated with greater hemodynamic stability and faster recovery when compared to propofol and midazolam.

 
  • References

  • 1 de la Morena F, Santander C, Esteban C, de Cuenca B, García JA, Sánchez J, et al. Usefulness of applying lidocaine in esophagogastroduodenoscopy performed under sedation with propofol. World J Gastrointest Endosc 2013;5:231-9.
  • 2 Ristikankare M, Julkunen R, Heikkinen M, Mattila M, Laitinen T, Wang SX, et al. Sedation, topical pharyngeal anesthesia and cardiorespiratory safety during gastroscopy. J Clin Gastroenterol 2006;40:899-905.
  • 3 Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: Current issues. World J Gastroenterol 2013;19:463-81.
  • 4 Wang D, Chen C, Chen J, Xu Y, Wang L, Zhu Z, et al. The use of propofol as a sedative agent in gastrointestinal endoscopy: A meta-analysis. PLoS One 2013;8:e53311.
  • 5 Lera dos Santos ME, Maluf-Filho F, Chaves DM, Matuguma SE, Ide E, Luz Gde O, et al. Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens. World J Gastroenterol 2013;19:3439-46.
  • 6 Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: Study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244-51.
  • 7 Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs 1998;13:148-55.
  • 8 Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: A novel sedative-analgesic agent. Proc (Bayl Univ Med Cent) 2001;14:13-21.
  • 9 Bajwa S, Kulshrestha A. Dexmedetomidine: An adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013;3:475-83.
  • 10 Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol 2007;21:25-9.
  • 11 Vázquez-Reta JA, Jiménez Ferrer MC, Colunga-Sánchez A, Pizarro-Chávez S, Vázquez-Guerrero AL, Vázquez-Guerrero AR. Midazolam versus dexmedetomidine for sedation for upper gastrointestinal endoscopy. Rev Gastroenterol Mex 2011;76:13-8.
  • 12 Sethi P, Mohammed S, Bhatia PK, Gupta N. Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial. Indian J Anaesth 2014;58:18-24.
  • 13 Muller S, Borowics SM, Fortis EA, Stefani LC, Soares G, Maguilnik I, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc 2008;67:651-9.
  • 14 Takimoto K, Ueda T, Shimamoto F, Kojima Y, Fujinaga Y, Kashiwa A, et al. Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer. Dig Endosc 2011;23:176-81.