Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
J Gastroenterol Hepatol. 2021 Jul;36(7):1920-1926. doi: 10.1111/jgh.15417. Epub 2021 Feb 4.
During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone.
This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections.
Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred.
The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.
在进行早期食管癌内镜黏膜下剥离术时，患者的身体有时会移动，这可能导致手术中断。丙泊酚和右美托咪定最近被发现是内镜黏膜下剥离术的有用镇静剂。本研究旨在探讨丙泊酚联合右美托咪定镇静是否能抑制食管内镜黏膜下剥离术中患者的身体运动，并与单纯丙泊酚镇静进行比较。
这是一项前瞻性、双盲、随机对照试验。前瞻性招募在横滨市立大学医院接受食管内镜黏膜下剥离术的早期食管癌患者，并随机分为丙泊酚组和丙泊酚联合右美托咪定组。主要终点是躁动发生率。次要终点是满意度评分、丙泊酚维持剂量和补救性丙泊酚注射次数。
共纳入 66 例患者（丙泊酚组：n=33；联合组：n=33）。联合组的躁动发生率明显低于丙泊酚组（3.0%比 27.3%，P=0.02）。在联合组，内镜医师的满意度评分明显更高，丙泊酚维持剂量明显更低，补救性丙泊酚注射次数也低于丙泊酚组（3.0%比 18.2%，P<0.001）。虽然联合组心动过缓的发生率明显更高（30.3%比 3.0%，P<0.01），但没有发生严重的不良反应。
丙泊酚联合右美托咪定联合用药可提供良好的镇静效果，有效抑制食管内镜黏膜下剥离术中患者的身体运动。
