CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(01): E3-E10
DOI: 10.1055/s-0043-122228
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?

Takashi Nonaka1, 2, Masahiko Inamori3, Tetsuya Miyashita4, Yumi Inoh2, Kenji Kanoshima2, Takuma Higurashi2, Hidenori Ohkubo2, Hiroshi Iida3, Koji Fujita5, Akihiko Kusakabe5, Takahisa Gotoh4, Atsushi Nakajima1
  • 1Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
  • 2Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
  • 3Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan
  • 4Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
  • 5Office of Postgraduate Medical Education, Yokohama City University Hospital, Yokohama, Japan
Further Information

Publication History

submitted 10 May 2017

accepted after revision 26 September 2017

Publication Date:
12 January 2018 (online)

Abstract

Background and study aims The aim of this pilot randomized controlled trial was to evaluate and compare the satisfaction of the endoscopist along with the effectiveness and safety of sedation between sedation protocol using a combination of propofol (PF) and dexmedetomidine (DEX) (Combination group) and sedation protocol using PF alone (PF group) during gastric endoscopic submucosal dissection (ESD).

Patients and methods Fifty-eight patients with gastric neoplasias scheduled for gastric ESD were enrolled and randomly assigned to the two groups. The satisfaction scores of the endoscopists and the parameters for the effectiveness and safety of sedation were evaluated by comparisons between the two groups.

Results The satisfaction scores of the endoscopists, which were measured using a visual analogue scale, were significantly higher in the Combination group than in the PF group (88 vs. 69, P = 0.003). The maintenance dose of PF was lower in the Combination group than in the PF group (2 mg/kg/h vs. 5 mg/kg/h, P < 0.001), and the number of rescue PF injections was fewer in the Combination group than in the PF group (2 times vs. 6 times, P < 0.001). The incidence of bradycardia (defined as a pulse rate ≤ 45 bpm) in the Combination group was higher than that in the PF group (37.9 % vs. 10.3 %, P = 0.029).

Conclusions This study suggests that gastroenterologist-directed sedation using a combination of PF and DEX during gastric ESD can enhance the satisfaction levels of endoscopists by providing stable sedation with an acceptable safety profile.