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.
Key words
Dexmedetomidine - midazolam - propofol - sedative - upper gastrointestinal endoscopy
