Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial

Abstract

BackgroundIn addition to propofol, dexmedetomidine is a suitable alternative for intraoperative sedation in procedures requiring regional anesthesia. To date, however, little is known about the influences of each drug on upper airway patency. Accordingly, the authors investigated differences between dexmedetomidine and propofol sedation in the occurrence of upper airway obstruction and requirements for airway intervention in patients with mild obstructive sleep apnea.MethodsPatients with an apnea/hypopnea index of 5–14/h according to Watch-PAT 200 analysis were enrolled in this study. Spinal anesthesia was routinely performed for surgery. Intraoperative sedation was initiated using either dexmedetomidine or propofol infusion at a level of modified observer’s assessment of alertness/sedation scale 3. The primary outcome was the proportion of patients exhibiting signs of upper airway obstruction. A sign of upper airway obstruction was defined as no detection of end-tidal carbon dioxide for at least 10 s despite respiratory efforts.ResultsA total of 50 patients were included in the final analysis (dexmedetomidine [n = 26]; propofol [n = 24]). During the intraoperative sedation period, there was a significantly lower proportion of patients exhibiting signs of upper airway obstruction in the dexmedetomidine group than in the propofol group (11.5% vs. 41.7%, P = 0.035). An artificial airway was inserted in 1 patients (3.8%) and 5 patient (20.8%) in the dexmedetomidine and propofol groups, respectively (P = 0.093).ConclusionDexmedetomidine sedation was associated with a lower incidence of upper airway obstruction than propofol sedation in patients with mild obstructive sleep apnea.Trial registration numberClinical trials.gov (NCT02993718): Retrospectively registered.

Dexmedetomidine Provides Fewer Respiratory Events Compared With Propofol and Fentanyl During Third Molar Surgery: A Randomized Clinical Trial

“…During the course of the trial, new studies with similar interventions reported a greater difference than that used to derive the initial sample size of 120 per group as per protocol. 25 Because of the recalculation of the sample size during this trial based on accumulating evidence, we used an adjusted a of .005 to account for the 3 revised power calculations performed and the multiple secondary outcomes. Using the statistical framework (.0313 vs .2667) for the final power analysis with the adjusted a level of .005, this study was expected to have 80% power with 61 patients in each group using the Fisher exact test.…”

“…Dexmedetomidine comes at a considerably higher expense than propofol, requires increased anesthetic delivery time, and does not have an FDA-approved reversal agent. Therefore, we recommend this as an alternative sedation protocol in patients who are obese, have a history of obstructive sleep apnea, 25 have high drug tolerance, or have a history of poor cooperation or respiratory events with propofol.…”

“…Oxygen desaturation (oxygen saturation < 92%) did not occur in any participants in either group. Within group D, significant decreases occurred in heart rate from baseline to after the loading bolus (15,20,25, and 30 minutes) (P < .0001).…”

The correlation between the STOP-Bang score and oxygen saturation during spinal anesthesia with dexmedetomidine sedation

“…Its sedation is similar to that of natural sleep; therefore, it is known to cause less respiratory depression [ 15 ]. However, the advantage of being similar to natural sleep implies that the incidence rate of OSA is high, as reported by Shin et al [ 16 ]. OSA has a causal relationship with hypoxia during sedation, and severe hypoxia may be associated with increased mortality and morbidity [ 6 ].…”

“…the incidence rate of OSA is high, as reported by Shin et al [16]. OSA has a causal relationship with hypoxia during sedation, and severe hypoxia may be associated with increased mortality and morbidity [6].…”