A comparison of efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

Abstract

Introduction: Endoscopic submucosal dissection (ESD) requires adequate sedation and pain control, for which the short acting drugs such as propofol and remifentanil are recommended. Dexmedetomidine has sedative and analgesic effects and suppresses gastrointestinal motility, which might be critical during ESD. We compared the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil for use during ESD.Method: 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/h/kg 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 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 = 0.01), 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. Conclusions: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, endoscopists favored dexmedetomidine perhaps due to lower gastric motility.