Dexmedetomidine in gastrointestinal endoscopic procedures

Table 1 The use of dexmedetomidine in a combination technique for gastrointestinal endoscopic procedures

Ref.	Type of endoscopy	No. of patients	DEX group	Non-DEX group	Summary of findings
Wu et al[17]	EGD	70	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, FEN 1 mcg/kg iv	PRO 0.6 mg/kg and on demand bolus 10-20 mg iv	DEX showed minimal adverse effects on respiratory function. More patients in PRO created deeper sedation at start
Cheung et al[31]	EGD	50	DEX 1.5 mcg/kg in, PCS with PRO and Alfentanil	Normal saline in, PCS with PRO and Alfentanil	DEX i.n. with PCS PRO and alfentanil presented deeper sedation with significantly fewer use of additional sedative agents during EGD
1EL-Shmaa et al[25]	EGD	100	DEX 1 mcg/kg followed by 0.5-1 mcg/kg per hour infusion iv, KET 1 mg/kg and on demand bolus 0.5 mg/kg iv	ETO 0.15 mg/kg followed by 0.01-0.03 mg/kg per minute infusion iv, FEN 1 mcg/kg iv	ETO/FEN combination provides shorter sedation times and lighter sedation level compared to DEX/KET combination
Wu et al[18]	EGD	60	DEX 0.3 mcg/kg followed by 0.2-0.3 mcg/kg per hour infusion iv, FEN 1 mcg/kg iv	MDZ 0.05 mg/kg iv, FEN 1 mcg/kg iv	DEX had a good safety profile and was an effective sedation for EGD procedure
1Koksal et al[32]	EGD	80	DEX 0.5 mcg/kg followed by 0.2 mcg/kg per hour infusion iv, KET 1 mg/kg iv	REM 0.5 mcg/kg followed by 0.1 mcg/kg per minute infusion iv, KET 1 mg/kg iv	REM/KET combination provides faster, more sedoanalgesia and rapid recovery compared with DEX/KET combination
Hashiguchi et al[20]	EGD	40	Group D: DEX 6 mcg/kg followed by 0.6 mcg/kg per hour infusion iv, Butylscopolamine 20 mg im, Lidocaine viscous 5 mL gurgling	Group M: MDZ 0.05 mg/kg iv, Butylscopolamine 20 mg im, Lidocaine viscous 5 mL gurgling; Group L: Lidocaine viscous 5 mL gurgling	DEX is as safe and effective as MDZ. DEX significantly reduces blood pressure and heart rate
Saleh et al[56]	Esophageal dilatation	60	Group D: DEX 2 mcg/kg followed by 0.4 mcg/kg per hour infusion iv, MDZ 0.05 mg/kg iv	Group P: PRO 1 mg/kg followed by 5 mg/kg per hour infusion iv; Group K: KET 2 mg/kg and on demand 0.5 mg/kg iv, Atropine 0.02 mg iv	DEX-MDZ combination and KET had more stable cardiorespiratory profiles, with adequate postprocedural analgesia
Ayazoglu et al[37]	Colonoscopy	121	DEX 0.2 mcg/kg iv, PRO 0.5-3 mg/kg per hour infusion iv	Group 1: SUF 0.1 mcg/kg in, PRO 0.5-3 mg/kg per hour infusion iv; Group 2: MEP 0.4 mg/kg iv, PRO 1 mg/kg bolus followed by 0.5-3 mg/kg per hour infusion iv; Group 3: MEP 0.4 mg/kg iv, MDZ 0.03 mg/kg iv, PRO 0.5-3 mg/kg per hour infusion iv	Sedation for colonoscopy can be safely and effectively utilized with low doses of PRO combined with DEX, in SUF, iv MEP and iv MEP with MDZ
Techanivate et al[36]	Colonoscopy	70	DEX 1 mcg/kg iv, FEN 0.5 mcg/kg iv, PRO 20 mg and on demand 20 mg iv	FEN 0.5 mcg/kg iv, PRO 1 mg/kg and on demand 20 mg iv	DEX for sedation in colonoscopy reduced hypotension incidence than PRO
Dere et al[34]	Colonoscopy	60	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, FEN 1 mcg/kg iv	MDZ 0.05 mg/kg iv, FEN 1 mcg/kg iv	DEX provided more hemodynamic stability, higher sedation scores, higher satisfaction scores and lower pain scores
Abdalla et al[43]	ERCP	60	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, PRO 5 mg/kg per hour and on demand bolus 0.5 mg/kg iv	KET 1 mg/kg followed by 0.5 mg/kg per hour infusion iv, PRO 5 mg/kg per hour and on demand bolus 0.5 mg/kg iv	DEX-PRO during ERCP showed better hemodynamic stability, less nausea/vomiting and shorter recovery time when compared with KET-PRO combination
1Ramkiran et al[54]	ERCP	72	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, MDZ 0.05 mg/kg iv, Hyoscine 0.3 mg/kg iv, PRO 0.5-1.5 mg/kg and on demand bolus 20 mg iv	Group K: KET 0.25 mg/kg followed by 5 mcg/kg per minute infusion iv, MDZ 0.05 mg/kg iv, Hyoscine 0.3 mg/kg iv, PRO 0.5-1.5 mg/kg and on demand bolus 20 mg iv; Group C: normal saline iv, MDZ 0.05 mg/kg iv, Hyoscine 0.3 mg/kg iv, PRO 0.5-1.5 mg/kg and on demand bolus 20 mg iv	Low dose KET with PRO boluses resulted in lesser PRO consumption, with earlier recovery and favorable hemodynamics compared with DEX in outpatient ERCP
Mukhopadhyay et al[46]	ERCP	45	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, MDZ 0.5 mg/kg iv, Pentazocine 6 mg iv, KET 25 mg iv, PRO 0.75-1 mg/kg and on demand bolus 10-20 mg iv	Group 1: MDZ 1 mg/kg iv, PRO 0.75-1 mg/kg and on demand bolus 10-20 mg iv; Group 2: MDZ 0.5 mg/kg iv, Pentazocine 6 mg iv, KET 25 mg iv, PRO 0.75-1 mg/kg and on demand bolus 10-20 mg iv	DEX increased efficacy and safety of sedate-analgesic cocktail. It reduces PRO requirement, more stable level of sedation and increases anesthetist satisfaction
Sethi et al[42]	ERCP	60	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, FEN 1 mcg/kg iv	MDZ 0.04 mg/kg and on demand bolus 0.5 mg iv, FEN 1 mcg/kg iv	DEX could be a superior alternative drug to MDZ for conscious sedation in ERCP
1Mazanikov et al[53]	ERCP	50	DEX 1 mcg/kg followed by 0.7 mcg/kg per hour infusion iv, PCS with PRO and Alfentanil	Group P: Normal saline, PCS with PRO and Alfentanil	DEX alone was insufficient in alcoholics. PCS with PRO and Alfentanil could be recommended
1Nagaraj et al[51]	ERCP	70	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv, FEN 1 mcg/kg iv	PRO 0.5 mg/kg followed by 2 mg/kg per hour infusion iv, FEN 1 mcg/kg iv	PRO/FEN combination provided better overall conditions when compared to DEX/FEN combination

¹Negative result of dexmedetomidine. EGD: Esophagogastroduodenoscopy; ERCP: Endoscopic retrograde cholangiopancreatography; DEX: Dexmedetomidine; MDZ: Midazolam; PRO: Propofol; FEN: Fentanyl; MEP; Meperidine; REM: Remifentanil; ETO: Etomidate; KET: Ketamine; SUF: Sufentanil; PCS: Patient controlled sedation.

Table 2 The use of dexmedetomidine in a single agent technique for gastrointestinal endoscopic procedures

Ref.	Type of endoscopy	No. of patients	DEX group	Non-DEX group	Summary of findings
Samson et al[21]	EGD	90	DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv	MDZ 0.04 mg/kg followed by an additional dose of 0.5 mg iv	Endoscopist satisfaction and recovery in DEX group was significantly better than in MDZ and PRO groups
Jiang et al[23]	EGD	40	DEX 0.8 mcg/kg iv	PRO 2.5 mg/kg iv	DEX could yield marked sedative effect, had antihypertensive effect and did not suppress respiration
Demiraran et al[22]	EGD	50	DEX 1 mcg/kg followed by 0.2 mcg/kg per hour infusion iv	MDZ 0.07 mg/kg (total dose 5 mg) iv	DEX was superior to MDZ with regard to retching, rate of adverse events and endoscopist satisfaction for EGD sedation
Sula et al[35]	Colonoscopy	231	DEX 1 mcg/kg iv	PRO 1.5 mg/kg and on demand bolus 0.4-0.5 mg/kg iv	Both regimens were effective and safe for sedation. PRO caused more desaturation, while DEX caused more hypotension
1Jalowiecki et al[38]	Colonoscopy	64	Group D: DEX 1 mcg/kg followed by 0.2 mcg/kg per hour infusion iv	Group P: 1 mg/kg of MEP with 0.05 mg/kg of MDZ iv, Group F: 0.1-0.2 mg of FEN iv on demand	There was a significantly greater decrease in heart rate and blood pressure in group D. Time to home readiness was the longest in group D
1Eldesuky Ali Hassan et al[48]	ERCP	50	Group D: DEX 1 mcg/kg followed by 0.5 mcg/kg per hour infusion iv	Group K: ketofol 1 mg/kg iv bolus followed by 50 mcg/kg per minute infusion iv	Time to achieve sedation score and total dose of rescue sedation were not significantly different. Patient and endoscopist satisfaction in group K was significantly higher than in group D
Kilic et al[40]	ERCP	50	Group D: DEX 1 mcg/kg followed by 0.2-0.7 mcg/kg per hour infusion iv	Group M: MDZ 0.04 mg/kg followed by an additional dose of 0.5 mg iv	DEX showed higher endoscopist satisfaction. Coughing, nausea and vomiting were observed in three patients in group M, but no patients in group D
Ceylan et al[41]	ERCP	50	Group D: DEX 1 mcg/kg followed by 0.2-0.7 mcg/kg per hour infusion iv	Group P: PRO 75 mcg/kg per hour followed by 12.5-100.0 mcg/kg per minute infusion iv	Blood pressure and heart rate values in group D were significantly lower than in group P. There were no significant differences in patient and endoscopist satisfaction
1Muller et al[52]	ERCP	26	Group D: DEX 1 mcg/kg followed by 0.2-0.5 mcg/kg per hour infusion iv	Group P: PRO (target plasma concentration 2-4 mcg/mL) with FEN 1 mcg/kg iv	DEX alone was not as effective as PRO combined with FEN. DEX was associated with greater hemodynamic instability and a prolonged recovery period
Eberl et al[55]	Esophageal intervention	64	DEX 1 mcg/kg (0.5 mcg/kg in age > 65) followed by 0.7-1 mcg/kg per hour infusion iv	PRO Target Controlled Infusion (OAAS scale ≤ 4)	DEX was a new representative for endoscopic sedation. The acceptance level after PRO was relatively high compared with DEX
Takimoto et al[58]	ESD	90	Group D: DEX 3 mcg/kg followed by 0.4 mcg/kg per hour infusion iv	Group P: PRO 5 mg bolus and 3 mg/kg per hour infusion iv, Group M: MDZ 0.1 mg/kg iv	DEX was effective and safe for patients with gastric tumors who underwent ESD

¹Negative result of dexmedetomidine. EGD: Esophagogastroduodenoscopy; ERCP: Endoscopic retrograde cholangiopancreatography; DEX: Dexmedetomidine; MDZ: Midazolam; PRO: Propofol; FEN: Fentanyl; MEP: Meperidine; REM: Remifentanil; ETO: Etomidate; KET: Ketamine; SUF: Sufentanil; PCS: Patient controlled sedation.