Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection.
anesthesia
dexmedetomidine
esophageal endoscopic submucosal dissection
propofol
randomized controlled trial
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
revised:
09
01
2021
received:
26
11
2020
accepted:
23
01
2021
pubmed:
29
1
2021
medline:
15
12
2021
entrez:
28
1
2021
Statut:
ppublish
Résumé
During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone. This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections. Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred. The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone.
METHODS
METHODS
This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections.
RESULTS
RESULTS
Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred.
CONCLUSION
CONCLUSIONS
The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.
Substances chimiques
Hypnotics and Sedatives
0
Dexmedetomidine
67VB76HONO
Propofol
YI7VU623SF
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1920-1926Informations de copyright
© 2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin. Gastroenterol. Hepatol. 2005; 3: S67-S70.
Oyama T. Esophageal ESD: technique and prevention of adverse events. Gastrointest. Endosc. Clin. N. Am. 2014; 24: 201-212.
Golparvar M, Saghaei M, Sajedi P, Razavi SS. Paradoxical reaction following intravenous midazolam premedication in pediatric patients-a randomized placebo controlled trial of ketamine for rapid tranquilization. Paediatr. Anaesth. 2004; 14: 924-930.
Nishizawa T, Suzuki H, Matsuzaki J, Kanai T, Yahagi N. Propofol versus traditional sedative agents for endoscopic submucosal dissection. Dig. Endosc. 2014; 26: 701-706.
Kiriyama S, Gotoda T, Sano H et al. Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection. J. Gastroenterol. 2010; 45: 831-837.
Yamagata T, Hirasawa D, Fujita N et al. Efficacy of propofol sedation for endoscopic submucosal dissection (ESD): assessment with prospective data collection. Intern. Med. 2011; 50: 1455-1460.
Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia 2007; 62: 690-701.
Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr. Opin. Anaesthesiol. 2006; 19: 404-410.
Michel-Macías C, Morales-Barquet DA, Reyes-Palomino AM, Machuca-Vaca JA, Orozco-Guillén A. Single dose of propofol causing propofol infusion syndrome in a newborn. Oxf Med Case Reports 2018; 2018: omy023.
Kamibayashi T, Maze M. Clinical uses of α2-adrenergic agonists. Anesthesiology 2000; 93: 1345-1349.
Barends CR, Absalom A, van Minnen B, Vissink A, Visser A. Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety. PLoS One 2017; 12: e0169525.
Yoshio T, Ishiyama A, Tsuchida T et al. Efficacy of novel sedation using the combination of dexmedetomidine and midazolam during endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus. 2019; 16: 285-291.
Cohen LB, Delegge MH, Aisenberg J et al. AGA institute review of endoscopic sedation. Gastroenterology 2007; 133: 675-701.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3: 1-150.
Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus 2017; 14: 1-36.
Nonaka T, Inamori M, Miyashita T et al. Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection? Endosc Int Open. 2018; 6: E3-E10.
Nonaka T, Inamori M, Miyashita T et al. Feasibility of deep sedation with a combination of propofol and dexmedetomidine hydrochloride for esophageal endoscopic submucosal dissection. Dig. Endosc. 2016; 28: 145-151.
Hamada K, Kawano K, Yamauchi A et al. Efficacy of endoscopic submucosal dissection of esophageal neoplasms under general anesthesia. Clin Endosc. 2019; 52: 252-257.
Yamashita K, Shiwaku H, Ohmiya T et al. Efficacy and safety of endoscopic submucosal dissection under general anesthesia. World J Gastrointest Endosc. 2016; 8: 466-471.
Kuwata NY, Gotoda T, Suzuki S, Mukai S, Itoi T, Moriyasu F. Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: a retrospective analysis in a single Japanese institution. Turk. J. Gastroenterol. 2016; 27: 91-96.
Safety Committee of Japanese Society of Anesthesiologists. JSA guideline for the management of malignant hyperthermia crisis 2016. J. Anesth. 2017; 31: 307-317.
Olsson GL, Hallen B. Laryngospasm during anaesthesia. A computer-aided incidence study in 136,929 patients. Acta Anaesthesiol. Scand. 1984; 28: 567-575.
Eichelsbacher C, Ilper H, Noppens R, Hinkelbein J, Loop T. Rapid sequence induction and intubation in patients with risk of aspiration: recommendations for action for practical management of anesthesia. Anaesthesist 2018; 67: 568-583.
El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia 2016; 71: 706-717.
Vetter L, Konrad C, Schüpfer G, Rossi M. Ventilator-associated pneumonia (VAP): a risk already at the time of anesthetic induction. Anaesthesist 2017; 66: 122-127.
Locke MC, Davis JC, Brothers RJ, Love WE. Assessing the outcomes, risks, and costs of local versus general anesthesia: a review with implications for cutaneous surgery. J. Am. Acad. Dermatol. 2018; 78: 983-988.
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin. Pharmacokinet. 2017; 56: 893-913.
Hoy SM, Keating GM. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs 2011; 71: 1481-1501.
Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr. Crit. Care Med. 2007; 8: 115-131.
Talon MD, Woodson LC, Sherwood ER, Aarsland A, McRae L, Benham T. Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. J. Burn Care Res. 2009; 30: 599-605.
Mason KP, Robinson F, Fontaine P, Prescilla R. Dexmedetomidine offers an option for safe and effective sedation for nuclear medicine imaging in children. Radiology 2013; 267: 911-917.
Lee SP, Sung IK, Kim JH et al. Comparison of dexmedetomidine with on-demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor. J. Dig. Dis. 2015; 16: 377-384.
Takimoto K, Ueda T, Shimamoto F et al. Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer. Dig. Endosc. 2011; 23: 176-181.
Kinugasa H, Higashi R, Miyahara K et al. Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study. Clin. Transl. Gastroenterol. 2018; 9: 167.