Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?

Watt, Stacey; Sabouri, Sassan; Hegazy, Rafeek A; Gupta, Puneet; Heard, Christopher

doi:10.1016/j.jclinane.2016.07.035

Cited by 18 publications

(20 citation statements)

References 22 publications

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“…On the other hand, Watt et al reported that there was no benefit of dexmedetomidine over propofol in deep sedation regarding upper airway obstruction [22]. Patients sedated with propofol also maintained spontaneous respiration; therefore, dexmedetomidine sedation may not be the only attributing factor to decreased occurrence of upper airway obstruction in the dexmedetomidine group.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Thus, clinicians seek agents capable of retaining hemodynamic stability and airway security more optimally during sedation. [34]…”

Section: Introductionmentioning

confidence: 99%

“…Many researchers have investigated the effects of Dex in procedural sedation alone or combination with other sedative drugs such as midazolam and propofol. [345678910]…”

Section: Introductionmentioning

confidence: 99%

Comparison of sedation between dexmedetomidine and propofol during transesophageal echocardiography: A randomized controlled trial

et al. 2019

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Background: This study aimed to compare sedation characteristics of dexmedetomidine (Dex) and propofol during transesophageal echocardiography (TEE) in cardiac patients. Methods: This clinical trial was conducted on 65 cardiac patients, who underwent TEE in a referral heart hospital. The patients were randomly divided into two groups: Dex ( n = 34) and propofol ( n = 31). The depth of sedation in the patients was assessed at 5-min intervals until the end of the TEE examination. The patient, physicians’ satisfaction was recorded. Furthermore, blood pressure, heart and respiratory rates, peripheral oxygen saturation, and the bispectral index (BIS) of the patients were measured. The occurrence of apnea, hypotension or bradycardia was documented. Results: Demographic variables were similar in both groups. Time from the beginning of sedation to the start of TEE was significantly longer in the Dex group ( P = 0.01). Duration of the TEE examination was not different between the two groups. Interestingly, the recovery time was shorter in the Dex group than in the propofol group. There were no significant differences regarding patient and physician satisfaction with sedation quality. Hemodynamic profile was mainly similar in both groups. There was a significantly lower BIS level in the Dex group. There was no significant difference in the incidence of apnea or hypotension between the groups. Conclusions: Time from the beginning of sedation with Dex was longer than that with propofol. However, Dex was able to provide satisfactory sedation levels, hemodynamic stability, short recovery time, and acceptable patient and practitioner satisfaction during TEE in our cardiac patients.

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“…Moreover, dexmedetomidine‐related dose‐dependent changes in airway morphology on cine MRI for children without OSA were minimal . Watt et al also reported that there was no difference in airway collapse between patients who were not expected to have a difficult airway when receiving propofol and dexmedetomidine for deep sedation for pediatric MRI. Taken together, these results suggest that the effect of dexmedetomidine on airway permeability is minimal in patients who are expected to have difficult airways.…”

Section: Discussionmentioning

confidence: 99%

A retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II

Kang

Shin

Gil

et al. 2018

Pediatric Anesthesia

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Summary Background Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose‐dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures. Aims The aim of this study was to evaluate the incidence of artificial airway interventions in patients sedated with propofol and compare it to that in patients sedated with dexmedetomidine in patients with mucopolysaccharidosis type II during magnetic resonance imaging procedures. Methods All mucopolysaccharidosis type II patients undergoing magnetic resonance imaging at our institution between April 2014 and February 2018 were included in this study. The patients were divided into two groups according to whether they were managed before and after the introduction of dexmedetomidine: those who were sedated with propofol (group P) and those who were sedated with dexmedetomidine (group D). Results Forty‐six sedations were performed in 27 patients. Artificial airway interventions were significantly more frequent during propofol‐based than dexmedetomidine‐based sedation: 14 of 32 (43.8%) in group P and 1 of 14 (7.1%) in group D (odds ratio, 10.11; 95% confidence interval, 1.18‐86.85; P = 0.018). Time to awake and time to discharge were similar between groups. Changes in hemodynamic variables also did not significantly differ between groups. Conclusion Dexmedetomidine provides an adequate level of sedation and is associated with lower rates of artificial airway interventions compared to propofol. Therefore, dexmedetomidine may offer advantages for preserving the native airway compared to propofol when administered during magnetic resonance imaging scans in patients with mucopolysaccharidosis type II.

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Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?

Cited by 18 publications

References 22 publications

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

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

Comparison of sedation between dexmedetomidine and propofol during transesophageal echocardiography: A randomized controlled trial

A retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II

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