Respiratory and hemodynamic effects of three different sedative regimens for drug induced sleep endoscopy in sleep apnea patients. A prospective randomized study

El-Kalla, Rehab S; Mourad, Mona Blough El

doi:10.23736/s0375-9393.19.13875-8

Cited by 8 publications

(9 citation statements)

References 30 publications

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“… Gastroenterologic procedure (n = 39) Eldesuky 46 Saudi Arabia (18–60) 58 50 1, 2 ERCP HR, MAP and SpO 2 1: 1 μg.kg −1 iv DEX for 10 min + 0.5 μg.kg −1 .h −1 infusion DEX 2: 1 mg.kg −1 ketofol for 10 min + 50 μg.kg −1 .min −1 ketofol Before and during the procedure No clear definition Respiratory and hemodynamic effects, sedation score, pain, recovery time, patient and physician satisfaction and adverse events and complications. Elkalla 47 Egypt (18–50) 61.7 60 1, 2, 3 Drug-induced sleep endoscopy NIBP, ECG, pulse oximeter and RSS 1: 1 μg.kg −1 iv DEX for 10 min + 0.3 μg.kg −1 .h −1 infusion DEX 2: 0.7 mg.kg −1 iv propofol for 10 min + 0.5 mg.kg −1 .h −1 infusion propofol 3: 1 mg.kg −1 ketofol (2 mg.mL −1 propofol + 2 mg mL −1 ketamine) for 10 min + 50 μg.kg −1 .h −1 infusion ketofol Before and during the procedure Incidence of oxygen desaturation Hemodynamic effects, time to achieve sufficient sedation level, recovery time, patient and physician satisfaction and adverse events and complications. Goyal 48 India (18–75) 71.1 90 1, 2, 3 ERCP Noninvasive MAP, ECG, SpO 2 , HR and impedance pneumography 1: 0.5 μg.kg −1 DEX and 1 mg.kg −1 ketamine in 2 divided boluses of each drug, alternately, for 30 seconds + 0.5 mg.kg −1 .h −1 infusion DEX + 1–2 mg.kg −1 .h −1 ketamine 2: 1 μg.kg −1 fentanyl + 1 mg.kg −1 bolus propofol + 2–4 mg.kg −1 .h −1 infusion propofol Before and during the procedure Efficacy and safety.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-five trials were judged to be low risk of bias in all domains. 86 , 90 , 64 , 66 , 107 , 78 , 68 , 41 , 87 , 23 , 24 , 25 , 81 , 36 , 69 , 103 , 58 , 92 , 105 , 29 , 85 , 37 , 62 , 47 , 93 Forty trials had unclear risk of bias, 15 , 16 , 51 , 20 , 28 , 30 , 21 , 106 , 84 , 108 , 32 , 82 , 89 , 109 , 110 , 95 , 96 , 40 , 19 , 52 , 56 , 22 , 49 , 27 , 54 , 72 , 39 , 83 , 70 , 60 , 45 , 50 , 79 , 102 …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Fonseca

Ferreira

Rouxinol-Dias

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Fonseca

Ferreira

Rouxinol-Dias

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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“…We have known that like midazolam, dexmedetomidine has moderately slow pharmacokinetics ( Barends et al, 2017 ). Elkalla and El Mourad (2020) reported that dexmedetomidine was associated with a longer recovery period when compared with a combination of midazolam and fentanyl. The difference in recovery time was not observed between these two groups in our study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

Xian-chao

Cui

et al. 2022

Front. Pharmacol.

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Objective: The aim of this study was to compare dexmedetomidine-butorphanol (DB) and midazolam-butorphanol (MB) combinations for sedation, and analgesia in burn patients undergoing dressing changes.Methods: A total of 56 ASA I–II burn patients were included in this single-center randomized clinical trial. The ages of these patients were between 20 and 60 years. TBSA ranged from 10% to 50%. They were randomized to group DB and group MB during dressing change. In the DB group, each patient received a bolus dose of dexmedetomidine (0.5 μg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). In the MB group, each patient received a bolus dose of midazolam (0.05 mg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). The primary outcomes were sedation scores and pain scores. The second outcomes were vital signs, side effects, and butorphanol consumption.Results: The sedation scores of these two groups did not differ significantly (p > 0.05), and the pain scores of these groups were not significantly different (p > 0.05). More patients had hypotension in the DB group than in the MB group (6 versus 0, p = 0.01), but the number of patients who had respiratory depression was higher in the MB group compared with the DB group (4 versus 0, p = 0.038). Butorphanol consumption in the MB group was higher than in the DB group (p = 0.025).Conclusion: Dexmedetomidine is comparable to midazolam when combined with butorphanol in burn patients during dressing change. Compared with midazolam, it has the advantage of opioid-sparing effect.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx&proj=130622], identifier [ChiCTR2100049325].

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“…In a study using low-dose dexmedetomidine (1 µg/kg for 10 min, followed by 0.2-1.4 µg/ kg/h) Cho et al [16] had reported inadequate sedation in one-half of the patients requiring an additional administration of propofol. Similarly, Elkalla and El Mourad [17] have recently reported about the need for propofol rescue doses with low-dose dexmedetomidine. As expected from dexmedetomidine effective dosage our results showed a tendency of dexemdetomidine to slow heart rate: there were no significant bradycardias though, and considering our adult patient population, we would not have implicated interventions due to hemodynamic instabilities often more precariuos in pediatric patients and nevertheless majority still considerably benign [18] .…”

Section: Discussionmentioning

confidence: 89%

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

Alicino¹,

Corso²,

Barbara³

et al. 2021

JOHNA

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Background: Drug-induced sleep endoscopy (DISE) has become a routine diagnostic tool to assess the upper airway in obstructive sleep apnea patients, enabling effective diagnosis and appropriate treatment of the obstruction site. A number of protocols with different drugs and availability of target-controlled infusion (TCI) systems have been reported and published, making comparisons between studies difficult. In recent years, dexmedetomidine has claimed a role as a potential alternative to propofol for DISE sedation. In a real-life study we compared the effects of dexmedetomidine continuous infusion or propofol-TCI in patients undergoing DISE on time to reach adequate observation conditions, cardio-respiratory parameters, and recovery. Methods: Pilot prospective, randomized not blinded, single center study. A total of 28 patients scheduled to have DISE were randomly assigned to either group P (N=14; propofol-TCI, initial propofol effect-site target concentration 2.0 µg/mL, increased by 0.3 µg/mL every 2 min) or group D (N=14; dexmedetomidine bolus 1 µg/kg over 10 min, followed by infusion at 0.7 µg/kg/h). Hemodynamic and respiratory variables (including SpO2 nadir), time to reach the observation window and overall DISE duration were recorded. Results: A total of 28 patients were enrolled and completed the study: the cohort included 26 males (92.85%) and 2 females (7.14%). The mean age was 45.4±11.1 years [interquartile (IQ), 25.0–65.0], body mass index 30.5±3.4 kg/m2 (IQ, 21.0–36.0), and apnea-hypopnea index 36.9±21.1 events/hour (IQ, 7.8–95.0). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Epworth Sleepiness Scale score, preprocedural SpO2 nadir, age, sex, or body mass index. Compared with group P, group D showed significant differences in SpO2 (higher nadir during DISE, 87.09±5.4% vs. 75.0±11.0; P<0.001) and heart rate (80.4±8.9 vs. 62.8±6.6; P<0.001). While group D had longer duration of endoscopic examination times and emergence time from sedation, the grading of site of obstructions were similar in the 2 groups. Conclusions: Dexmedetomidine seems a limited, if viable, clinical alternative for DISE when propofol is contraindicated or not available: while causing higher SpO2 nadirs compared with propofol, it has a slow onset and longer recovery time, increasing total procedural time. Studies with greater patient numbers are needed to confirm these observations.

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Respiratory and hemodynamic effects of three different sedative regimens for drug induced sleep endoscopy in sleep apnea patients. A prospective randomized study

Cited by 8 publications

References 30 publications

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

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