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Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

 Namo Kim  ;  Young-Chul Yoo  ;  Sang Kil Lee  ;  Hyunzu Kim  ;  Hyang Mi Ju  ;  Kyeong Tae Min 
 WORLD JOURNAL OF GASTROENTEROLOGY, Vol.21(12) : 3671-3678, 2015 
Journal Title
Issue Date
Aged ; Dexmedetomidine/administration & dosage* ; Dexmedetomidine/adverse effects ; Dissection/adverse effects ; Dissection/methods* ; Double-Blind Method ; Female ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery* ; Gastroscopy/adverse effects ; Gastroscopy/methods* ; Humans ; Hypnotics and Sedatives/administration & dosage* ; Hypnotics and Sedatives/adverse effects ; Male ; Middle Aged ; Piperidines/administration & dosage* ; Piperidines/adverse effects ; Propofol/administration & dosage* ; Propofol/adverse effects ; Republic of Korea ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Treatment Outcome
Dexmedetomidine ; Efficacy ; Endoscopic submucosal dissection ; Peristalsis ; Safety
AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil. METHODS: 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/kg per hour 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 oxygen 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 = 0.010), 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. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477). CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Namo(김남오) ORCID logo https://orcid.org/0000-0002-0829-490X
Min, Kyeong Tae(민경태) ORCID logo https://orcid.org/0000-0002-3299-4500
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
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