COMPARISON OF THE EFFECTIVENESS AND SAFETY BETWEEN INTRAVENOUS DEXMEDETOMIDINE WITH FENTANYL VERSUS INTRAVENOUS PROPOFOL WITH FENTANYL FOR SEDATION IN DIAGNOSTIC UPPER GASTROINTESTINAL ENDOSCOPY
DOI:
https://doi.org/10.22159/ajpcr.2024.v17i3.49596Keywords:
Gastrointestinal endoscopy, sedation, analgesia, dexmedetomidine, propofol, fentanyl.Abstract
Objective: The aim of this study was to compare the effectiveness and safety of intravenous dexmedetomidine with fentanyl versus intravenous propofol with fentanyl for sedation in diagnostic upper gastrointestinal (GI) endoscopy.
Methods: 50 patients of ASA grade I, II, or III scheduled for GI endoscopy were randomly divided into two groups of 25 patients each. Group D received intravenous fentanyl and intravenous dexmedetomidine, and Group P received intravenous fentanyl and intravenous propofol. Hemodynamic variables, level of sedation using the Ramsay sedation score (RSS), patient satisfaction, and surgeon satisfaction using the visual analog scale (VAS) were recorded.
Results: There was no significant difference in the demographic parameters (age, gender, weight, ASA class) between the two groups. The mean time to reach RSS 4–5 was less in group P (27.60±6.44 s) when compared to group D (521.56±39.13 sec; p=0.0004). Patient satisfaction was higher in group D (7.9±0.7) as compared to group P (7.3±0.8; p=0.0069). While there was no significant difference in the surgeon’s satisfaction regarding difficulty during the procedure (8.3±0.9 and 7.9±1.3 in group D and group P, respectively; p=0.2120).
Conclusion: Dexmedetomidine with fentanyl resulted in a better hemodynamic profile, respiratory profile, patient satisfaction, and quicker recovery than propofol with fentanyl. Whereas propofol with fentanyl provided quicker onset and more efficient sedation compared to dexmedetomidine with fentanyl.
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References
Ersöz F, Toros AB, Aydoğan G, Bektaş H, Ozcan O, Arikan S. Assessment of anxiety levels in patients during elective upper gastrointestinal endoscopy and colonoscopy. Turk J Gastroenterol 2010;21:29-33. doi: 10.4318/tjg.2010.0044. PMID: 20533109
El-Hassan H, McKeown K, Muller AF. Clinical trial: Music reduces anxiety levels in patients attending for endoscopy. Aliment Pharmacol Ther 2009;30:718-24. doi: 10.1111/j.1365-2036.2009.04091.x
Amornyotin S. Sedation and monitoring for gastrointestinal endoscopy. World J Gastrointest Endosc 2013;5:47-55. doi: 10.4253/wjge.v5.i2.47
Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in enhanced recovery after surgery (ERAS) protocols for postoperative pain. Curr Pain Headache Rep 2020;24:21. doi: 10.1007/s11916-020-00853-z
Sahinovic MM, Struys MM, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet 2018;57:1539- 58. doi: 10.1007/s40262-018-0672-3
Kalyan S, Shantiraj G. A comparative study on effect of fentanyl with propofol and fentanyl with dexmedetomidine as intravenous anaesthetics for upper GI endoscopy. J Evid Based Med Healthc 2018;5:2204-8. doi: 10.18410/jebmh/2018/456
Samson S, George SK, Vinoth B, Khan MS, Akila B. Comparison of dexmedetomidine, midazolam, and propofol as an optimal sedative for upper gastrointestinal endoscopy: A randomized controlled trial. J Dig Endosc 2014;5:51-7. doi: 10.4103/0976-5042.144826
Hasanin AS, Sira AM. Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in pediatric patients. Egypt J Anaesth 2014;30:21-6. doi: 10.1016/j.egja.2013.09.006
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. doi: 10.1016/j.gie.2007.09.041. PMID: 18291396
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. doi: 10.4103/0019-5049.126782
Basarigidad A, Killedar S. Comparative study of safety and efficacy between propofol-fentanyl versus propofol-dexmedetomidine combination for sedation in upper gastro-intestinal (GI) endoscopic procedures- a prospective randomized study. Acad Anesthesiol Int 2019;4:67-70. doi: 10.21276/aan.2019.4.2.18
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. doi: 10.1155/2007/350279. PMID: 17225879; PMCID: PMC2656627
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Copyright (c) 2023 Rajesh Nakum, Sunaina Patel , shweta Patel, Krishna Padsala
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