Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3671
Peer-review started: September 14, 2014
First decision: October 14, 2014
Revised: November 17, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: March 28, 2015
AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil.
METHODS: Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidine-remifentanil (DR) group or a propofol-remifentanil (PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer’s Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety.
RESULTS: Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group (“very easy” 24.1% vs 56.7%, P = 0.010), gastric motility was more suppressed in the DR group (“no + mild” 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group (“very good + good” 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477).
CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.
Core tip: Propofol and remifentanil are effectively used for endoscopic procedures. However, deep sedation especially with propofol is frequently associated with cardiorespiratory complications; therefore, it is of interest to identify shallower yet equally effective sedation protocols. Dexmedetomidine allows sedation without respiratory depression, and has also been utilized for sedation for endoscopic procedures. This study compared the efficacy and safety between propofol-remifentanil and dexmedetomidine-remifentanil during endoscopic submucosal dissection (ESD) from the perspective of the endoscopist and the patient. We found that efficacy and safety of dexmedetomidine-remifentanil were comparable to propofol-remifentanil during ESD, but the endoscopists favored the dexmedetomidine-remifentanil regimen perhaps due to lower gastric motility.