Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP - 23/08/11
Porto Alegre, Brazil
Abstract |
Background |
Propofol is an accepted method of sedation for an ERCP and generally achieves deep sedation rather than conscious sedation, and dexmedetomidine has sedative properties of equivalent efficacy.
Objective |
To examine the hypothesis that dexmedetomidine is as effective as propofol combined with fentanyl for providing conscious sedation during an ERCP.
Design and Setting |
Randomized, blind, double-dummy clinical trial.
Patients |
Twenty-six adults, American Society of Anesthesiologists status I to III, underwent an ERCP.
Interventions |
Patients were randomized to receive either propofol (n = 14) (target plasma concentration range 2-4 μg/mL) combined with fentanyl 1 μg/kg, or dexmedetomidine (n = 12) 1 μg/kg for 10 minutes, followed by 0.2 to 0.5 μg/kg/min. Additional sedatives were used if adequate sedation was not achieved at the maximum dose allowed.
Main Outcomes Measurements |
The sedation level was assessed by the Richmond alertness-sedation scale and the demand for additional sedatives. Furthermore, heart rate, blood pressure, oxygen saturation, and respiratory rate were continuously assessed.
Results |
The relative risk (RR) was 2.71 (95% CI, 1.31-5.61) and the number of patients that needed to be treated (NNT) was 1.85 (95% CI, 1.19-4.21) to observe one additional patient with drowsiness 15 minutes after sedation in the dexmedetomidine group. Also, the RR was 9.42 (95% CI, 1.41-62.80), and the NNT was 1.42 (95% CI, 1.0-2.29) to require additional analgesic. However, there was also a greater reduction in blood pressure, a lower heart rate, and greater sedation after the procedure.
Conclusions |
Dexmedetomidine alone was not as effective as propofol combined with fentanyl for providing conscious sedation during an ERCP. Furthermore, dexmedetomidine was associated with greater hemodynamic instability and a prolonged recovery.
Le texte complet de cet article est disponible en PDF.Abbreviations : ANOVA, ASA, BP, ETCO2, HR, IQR, MAP, NNT, RASS, RR, SpO2, TCI
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Vol 67 - N° 4
P. 651-659 - avril 2008 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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