Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

Abstract

Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 µg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

Effect of medetomidine, midazolam, ketamine, propofol and isoflurane on spinal reflexes in healthy dogs

“…Not only in the presence of bicuculline (GABA receptor antagonist), but also in the presence of strychnine (glycine receptor antagonist) and a combination of bicuculline and strychnine reduce nerve activity and thus reduce polysynaptic reflexes (Grasshoff & Antkowiak, 2004). In the present study, as in previous studies, a synergistic effect for the duration of anaesthesia and smooth muscle relaxation was observed in the concomitant use of isoflurane with medetomidine and midazolam (Koruk et al, 2020).…”

“…According to the above explanations, it seems that in addition to the animal species, the dose of the drug used is also effective in the mechanism of action of the drug (Kim et al., 2007 ). It has been reported that, due to the synergistic effect, the duration of anaesthesia and smooth muscle relaxation is significantly increased in the combination of medetomidine and midazolam with propofol (Koruk et al., 2020 ). In the present study, this synergistic effect was seen and spinal reflexes were reduced in the propofol group.…”

Dexmedetomidine Versus Propofol for Patients With Sepsis Requiring Mechanical Ventilation: A Systematic Review and Meta-Analysis

“…Compared with propofol, DEX has been reported to improve patient’s ability to communicate pain ( Senem et al, 2020 ). As is known to all, in 2010, a significant randomized controlled trial named MENDS was conducted by Pandharipande PP, et al, which showed that DEX could reduce 28-day mortality in patients with sepsis, compared with those receiving lorazepam ( Pandharipande Pratik et al, 2010 ).…”

Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study

“…The sample size calculation was based on the primary outcome of the cumulative dose of propofol during ERCP. According to a previous study about the reduced consumption of propofol by dexmedetomidine during ERCP [ 12 ], we calculated the sample size and found 26 patients each group were required considering a 10% dropout rate (power = 0.8, α = 0.05).…”