Wu Y, Zhang Y, Hu X, Qian C, Zhou Y, Xie J
Department of Anaesthesiology, the Second Hospital of Anhui Medical University, Hefei, China.
Department of Endoscopy, the Second Hospital of Anhui Medical University, Hefei, China.
J Clin Pharm Ther. 2015 Aug;40(4):419-25. doi: 10.1111/jcpt.12282. Epub 2015 May 13.
Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure which requires sedation for most patients. We undertook a prospective, randomized, double-blinded study to compare the effect of propofol vs. dexmedetomidine on the sedation of outpatients during EGD.
Prior to the procedure, outpatients received either propofol at 0·6 mg/kg, with additional doses of 10-20 mg until the Observer's Assessment of Alertness/Sedation Scale (OAA/S) score reached 2-4, or dexmedetomidine at a loading dose of 1 μg/kg over a 10-min period followed by a 0·5 μg/kg/h infusion until the OAA/S score reached 2-4. Vital signs, sedation level, adverse events, patients' and endoscopist's satisfaction score, and an evaluation of the recovery time were assessed.
Negligible haemoglobin oxygen saturation (SpO2 ) and respiratory rate variations were observed in both groups, although respiratory depression occurred in two cases (5·9%) in the propofol group. Mean arterial pressure (MAP) in the propofol group decreased during the procedure compared with baseline (P < 0·05) and was also lower in comparison with the dexmedetomidine group (P < 0·05). Heart rate (HR) decreased after the loading dose in the dexmedetomidine group (P < 0·05). More patients in the propofol group underwent deeper sedation at the beginning of the procedure (P < 0·05), although the recovery time was comparable between the two groups (P > 0·05). Three cases (9·1%) in the dexmedetomidine group were delayed because of dizziness, bradycardia and nausea. There was a higher satisfaction score among patients in the propofol group (P < 0·05), although the endoscopist's satisfaction score was comparable between the two groups (P > 0·05).
Propofol and dexmedetomidine provide a relatively satisfactory level of sedation without clinically notable adverse effects during EGD. In addition, patients preferred propofol administration for the deeper sedation and rapid recovery, and dexmedetomidine exhibited minimal adverse effects on respiratory function.
食管胃十二指肠镜检查（EGD）是一种常见的诊断程序，大多数患者需要镇静。我们进行了一项前瞻性、随机、双盲研究，比较丙泊酚与右美托咪定在EGD期间对门诊患者镇静的效果。
在检查前，门诊患者要么接受0.6mg/kg的丙泊酚，必要时追加10 - 20mg剂量，直至观察者警觉/镇静评分（OAA/S）达到2 - 4分；要么接受右美托咪定，在10分钟内静脉输注负荷剂量1μg/kg，随后以0.5μg/（kg·h）持续输注，直至OAA/S评分达到2 - 4分。评估生命体征、镇静水平、不良事件、患者及内镜医师的满意度评分以及恢复时间。
两组患者的血红蛋白氧饱和度（SpO2）和呼吸频率变化均不明显，尽管丙泊酚组有2例（5.9%）出现呼吸抑制。丙泊酚组的平均动脉压（MAP）在检查过程中较基线下降（P < 0.05），且低于右美托咪定组（P < 0.05）。右美托咪定组在负荷剂量后心率下降（P < 0.05）。丙泊酚组更多患者在检查开始时达到较深镇静水平（P < 0.05），尽管两组恢复时间相当（P > 0.05）。右美托咪定组有3例（9.1%）因头晕、心动过缓和恶心而延迟恢复。丙泊酚组患者的满意度评分较高（P < 0.05），但两组内镜医师的满意度评分相当（P > 0.05）。
丙泊酚和右美托咪定在EGD期间提供了相对满意的镇静水平，且无明显临床不良反应。此外，患者因丙泊酚能产生较深镇静和快速恢复而更倾向于使用，右美托咪定对呼吸功能的不良影响最小。
