A Comparison Of Dexmedetomidine And Propofol Used In Patients Undergoing Endoscopic Variceal Ligation

Objective To compare the security and effect of dexmedetomidine and propofol both combined with fentanyl used in patients undergoing endoscopic variceal ligation(EVL). Methods Sixty patients undergoing selective EVL were randomly distributed into three groups:pethidine group(A), propofol-fentanyl group(B) and dexmedetomidine-fentanyl group(C). There was no difference of patients’ gender, age, weight, esophageal varices morphology and Child-Pugh grading in three groups (P>0.05). All the patients were asked for fasting for8h and no drinking for6h before operations, and didn’t use preoperative medication. The patients accepted oral cavity and throat surface anesthesia with2%lidocaine before entering the operating room. The patients kept left lateral position and accepted nasal catheter Oxygen Inhalation with oxygen flow rate5L/min after entering the operating room. The patients of Group A accepted intramuscular injection50mg pethidine,15min later began the operation. Group B accepted intravenous injection1.0ug/kg fentanyl, then1.5mg/kg propofol constant infusion in3min, maintenance of anesthesia with"9-7-5" intravenous pumping scheme. Group C accepted intravenous injection1.0μg/kg fentanyl, then1.5μg/kg dexmedetomidine intravenous pumping in lOmin. All the operations were done by one surgeon. The patients recovered to Ramsay score2-3after finished operation were transferred to observation room, and anesthesia ended.The data concerning blood pressure, heart rate, peripheral oxygen saturation and Ramsay score, endoscopic operation and anesthesia time, surgeon’s satisfaction and adverse reactions were recorded. Follow-up was done24hours later to confirm the patients’satisfaction and incidence of intraoperative awareness. Results All the patients finished operation successfully.There was no difference of General Information between the three groups.The Ramsay score of Group B(5.2±0.3) and C(3.5±0.4) were significantly higher than group A(1.6±0.4)(P<0.05). After anesthesia induction, HR and MAP decreased significantly in group B, while HR and MAP increased significantly during the operation in group A, HR and MAP in group C were relatively stable. The incidence of hyoxemia of group C was significantly lower than group B. There was no cough, nausea, body movement or high blood pressure happening during the EVL in group B or C, while the incidence of group A(40%,60%,40%and30%) was obviously higher(P<0.05). The surgeon’s satisfaction of group B (9.2±0.3) and C(9.6±0.4) were significantly higher than group A (5.0±0.4)(P<0.05), The patients’satisfaction of group B (9.6±0.3) and C (9.5±0.3) were also markedly higher than group A(5.4±0.3)(P<0.05). There was no difference of operation time between the3groups. The anesthesia time of group A (44±6)was obviously longer than group B (35±4) and C(36±5)(P<0.05). There was no difference of patients’or surgeon’s satisfaction, or anesthesia time between group B and C, but the incidence of bradycardia(40%), hypotension(30%) and hyoxemia(30%) in group B were obviously higher than group C(5%,0,0)(P<0.05). There was no intraoperative awareness happening in group B and C. Conclusion Both dexmedetomidine and propofol combining with fentanyl were superior to pethidine used in patients undergoing EVL while dexmedetomidine conscious sedation provided better hemodynamics and respiratory conditions compared with propofol.