Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Single-centre randomized controlled trial

Abstract

Summary What is known and objective The most appropriate sedative agent for conscious sedation in minor hysteroscopic surgeries is still unclear. Dexmedetomidine a sedative and analgesic agent, may be appropriate for outpatient procedures. The aim of our study was to compare the sedative, analgesic and hemodynamic effects of dexmedetomidine vs propofol in combination with fentanyl and midazolam in patients undergoing minor hysteroscopy surgery. Methods Sixty patients undergoing minor hysteroscopic surgery were randomized to receive either dexmedetomidine (n = 30) or propofol (n = 30) groups. Dexmedetomidine was infused at 1 µg/kg for 10 minutes followed by a 0.7 µg/kg/h maintenance infusion. Propofol was infused a bolus of 1.5 mg/kg followed by a 2.5 mg/kg/h maintenance infusion. Fentanyl 1.5 mcg/kg and midazolam 0.03 mg/kg were performed to all patients as premedication therapy before the hysteroscopic surgery. Post‐operative pain score was assessed with visual analogue scale (VAS). Hemodynamic variables and Riker Sedation‐Agitation Scale (SAS) scores were recorded for all patients. Results Mean arterial pressure and heart rate in the dexmedetomidine group were significantly lower than in propofol group, whereas SpO2 was similar between two groups. In addition, post‐operative Riker SAS and VAS scores were significantly lower in dexmedetomidine group than in the propofol group. Bradycardia, hypotension and serious adverse events did not occur in any patients. What is new and conclusion Dexmedetomidine was associated with better analgesia and lower post‐operative pain score than propofol in patients undergoing hysteroscopic surgery. However, arterial pressure and heart rate should be more closely monitored in patients received dexmedetomidine.

Authors’ reply to Dr. Bailong’s commentary: Assessing the sedation effect of dexmedetomidine during hysteroscopic surgery

“…We would like to the thank Bailong et al 1 for their interest in our recently published article entitled "Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Singlecentre randomized controlled trial" in the Journal. 2 We agree with the authors that both drugs (dexmedetomidine and propofol) should have been administered in identical syringes with the tubes covered. However, in our view this did not introduced observation bias.…”

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Authors' reply to Dr. Bailong's commentary: Assessing the sedation effect of dexmedetomidine during hysteroscopic surgeryWe would like to the thank Bailong et al 1 for their interest in our recently published article entitled "Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Singlecentre randomized controlled trial" in the Journal. 2 We agree with the authors that both drugs (dexmedetomidine and propofol) should have been administered in identical syringes with the tubes covered. However, in our view this did not introduced observation bias.Because all haemodynamic data (mean arterial pressure, heart rate and oxygen saturation) were recorded from the patient's monitoring.

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The effects of dexmedetomidine and tramadol on post‐operative pain and agitation, and extubation quality in paediatric patients undergoing adenotonsillectomy surgery: A randomized trial

“…Dexmedetomidine (Precedex, Pfizer) is a selective alpha‐2 agonist that has sedative, analgesic and anxiolytic properties . It also reduces stress responses to adenotonsillectomies without causing respiratory depression.…”

“…Dexmedetomidine (Precedex, Pfizer) is a selective alpha-2 agonist that has sedative, analgesic and anxiolytic properties. 7,8 It also reduces stress responses to adenotonsillectomies without causing respiratory depression. Previous studies have shown that dexmedetomidine produced a beneficial effect in paediatric patients and reduced post-operative agitation and pain.…”

Assessing the sedation effect of dexmedetomidine during hysteroscopic surgery

“…We have read an article written by Bingol et al with great interest. 1 It is a welcome investigation which evaluated the sedative, analgesic and hemodynamic effects of dexmedetomidine (DEX) vs propofol in patients undergoing minor hysteroscopy surgery. We agree with their conclusion that DEX may be a useful sedative agent during hysteroscopy procedure.…”