Muller Suzana, Borowics Silvia M, Fortis Elaine A F, Stefani Luciana C, Soares Gabriela, Maguilnik Ismael, Breyer Helenice P, Hidalgo Maria Paz L, Caumo Wolnei
Anesthesia and Perioperative Medicine Service, Gastroenterology Division, Hospital de Clínicas de Porto Alegre, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Gastrointest Endosc. 2008 Apr;67(4):651-9. doi: 10.1016/j.gie.2007.09.041. Epub 2008 Mar 4.
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.
To examine the hypothesis that dexmedetomidine is as effective as propofol combined with fentanyl for providing conscious sedation during an ERCP.
Randomized, blind, double-dummy clinical trial.
Twenty-six adults, American Society of Anesthesiologists status I to III, underwent an ERCP.
Patients were randomized to receive either propofol (n = 14) (target plasma concentration range 2-4 microg/mL) combined with fentanyl 1 microg/kg, or dexmedetomidine (n = 12) 1 microg/kg for 10 minutes, followed by 0.2 to 0.5 microg/kg/min. Additional sedatives were used if adequate sedation was not achieved at the maximum dose allowed.
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.
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.
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.
丙泊酚是一种公认的用于内镜逆行胰胆管造影术（ERCP）的镇静方法，通常能达到深度镇静而非清醒镇静，右美托咪定具有同等疗效的镇静特性。
检验右美托咪定在ERCP期间提供清醒镇静与丙泊酚联合芬太尼效果相同的假设。
随机、盲法、双模拟临床试验。
26名美国麻醉医师协会分级为I至III级的成年人接受了ERCP。
患者被随机分为接受丙泊酚（n = 14）（目标血浆浓度范围为2 - 4微克/毫升）联合1微克/千克芬太尼，或右美托咪定（n = 12）1微克/千克，持续10分钟，随后以0.2至0.5微克/千克/分钟的速度给药。如果在允许的最大剂量下未达到充分镇静，则使用额外的镇静剂。
通过里士满警觉 - 镇静量表和对额外镇静剂的需求来评估镇静水平。此外，持续评估心率、血压、血氧饱和度和呼吸频率。
右美托咪定组在镇静后15分钟观察到多1例嗜睡患者的相对危险度（RR）为2.71（95%可信区间，1.31 - 5.61），需要治疗的患者数（NNT）为1.85（95%可信区间，1.
