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Comparison of three sedation regimens for drug-induced sleep endoscopy

 Jin Sun Cho  ;  Sara Soh  ;  Eun Jung Kim  ;  Hyung-ju Cho  ;  Seokyung Shin  ;  Hye Jin Kim  ;  Bon-Nyeo Koo 
 SLEEP AND BREATHING, Vol.19(2) : 711-717, 2015 
Journal Title
Issue Date
Adult ; Airway Resistance/physiology* ; Conscious Sedation/methods* ; Dexmedetomidine/administration & dosage* ; Dexmedetomidine/adverse effects ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Endoscopy/methods* ; Female ; Humans ; Male ; Middle Aged ; Oxygen/blood ; Piperidines/administration & dosage* ; Piperidines/adverse effects ; Polysomnography/methods* ; Propofol/administration & dosage* ; Propofol/adverse effects ; Sleep Apnea, Obstructive/diagnosis* ; Sleep Apnea, Obstructive/physiopathology*
Obstructive sleep apnea ; Drug-induced sleep endoscopy ; Dexmedetomidine ; Propofol ; Remifentanil
PURPOSE: Drug-induced sleep endoscopy (DISE) allows for direct airway observation in patients with obstructive sleep apnea. This study compared the safety profiles and efficacies of three regimens for DISE. METHODS: Sixty-six patients were randomly assigned to receive propofol alone (n = 22), a propofol-remifentanil combination (n = 22), or a dexmedetomidine-remifentanil combination (n = 22). Remifentanil was infused at a concentration of 1.5 ng·ml(-1) in the propofol-remifentanil and dexmedetomidine-remifentanil groups, whereas saline was infused in the propofol group. The propofol and propofol-remifentanil groups received propofol at a starting concentration of 1.0 μg·ml(-1), then 0.1 μg·ml(-1) increments at 5 min intervals. The dexmedetomidine-remifentanil group received 1.0 μg·kg(-1) loading dose of dexmedetomidine for 10 min and then 0.2 μg·kg(-1)·h(-1) increments at 5 min intervals. RESULTS: The incidence of oxygen desaturation was significantly higher in the propofol-remifentanil group compared with that of the dexmedetomidine-remifentanil group (77 vs. 45%, respectively, P = 0.024). Even with a maximum dose of dexmedetomidine (1.4 μg·kg(-1)·h(-1)), 50% of the dexmedetomidine-remifentanil group did not reach sufficient sedation and required additional propofol. Cough reflex occurred in five patients of propofol group and in neither of the other groups (P = 0.004). CONCLUSIONS: The propofol-remifentanil combination was associated with a higher incidence of desaturation. The dexmedetomidine-remifentanil combination was associated with inadequate sedation in one half of the patients, even though it produced less respiratory depression. Addition of remifentanil reduced the cough reflex.
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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 Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Kim, Eun Jung(김은정) ORCID logo https://orcid.org/0000-0002-5693-1336
Kim, Hye Jin(김혜진) ORCID logo https://orcid.org/0000-0003-3452-477X
Soh, Sa Rah(소사라) ORCID logo https://orcid.org/0000-0001-5022-4617
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Cho, Jin Sun(조진선) ORCID logo https://orcid.org/0000-0002-5408-4188
Cho, Hyung Ju(조형주) ORCID logo https://orcid.org/0000-0002-2851-3225
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