Clinical Safety And Efficacy Of Dexmedetomidine For Sedation During ERCP

Background and ObjectiveCompared with gastroenteroscopy,ERCP is applied more to elderly patients,who may have more complications.The duration of ERCP is longer,and patients are prone or to the left,which may cause more difficulty in respiratory management.It is a transoral endoscopy,which will cause intense discomfort and pain to patients.To address these concerns,ERCP need both effective analgesia and sedation to provide comfort and ensure safety at the same time.Propofol is the most widely used sedative for ERCP,but adverse effects of circulatory and respiratory systems are inevitable.Dexmetomidine causes less problem on respiration,and has been safe in airway management.It can reduce the number and time of artificial intervention by anesthesiologists.The aim of this study is to determine whether dexmetomidine in ERCP can be as effective as propofol.The comparative study provides more guidence for the further improvement of clinical ERCP anesthesia procedure.MethodsA total of 66 patients?age 45-85 years old,male 38,female 28,with ERCP ASA I-III grade?were enrolled in this study.The patients were randomly divided into two groups with 33 in each group:dexmetomidine group?group D,M 20,F13?and propofol group?group P,M 18,F 15?.D group for initial sedation:dexmetomidine 2ug/kg/h loading pump was injected for 10 minutes.It was maintained with 2ug/kg/h speed pump for the rest of the procedure.P group:propofol 2.0ug/ml TCI per 3min.For both groups,the sedation was assessed with RASS scores.For RASS score greater than-2,the propofol target concentration was increased to 0.3ug/ml per time.Anaesthesis-related complications and adverse events were inquired twice after operation.Pulse oxygen saturation,respiratory frequency,hypoxemia?SpO₂<90%?,severe hypoxemia?SpO₂<85%?,duration,treatment mode,artificial intervention time/non-artificial intervention time,sedation score were recorded.Time away from Endoscopic Center,Doctor satisfaction,patient satisfaction,Special disposal medication were also reported.All of the above measurements are analyzed statistically.ResultsThere was no significant difference between dexmedetomidine group?group D?and propofol group?group P?in general patient medical data and operation-related data?P>0.05?.The ratio of manual intervention time to non-manual intervention time in group D was significantly lower than that in group P?P<0.05?.The difference was statistically significant in patients with hypoxemia in group D?SpO₂<90%?.There was no significant difference in the number of patients with severe hypoxemia?SpO₂<85%?and pulse oxygen saturation?P>0.05?.The mean intraoperative arterial pressure in group P was significantly lower than that in group D,and there were more patients with hypotension requiring infusion of colloid and booster drugs?P<0.05?.The respiratory frequency?RR?in group P was significantly lower than that in group D at different time points after induction?P<0.05?.The sedation depth?BIS?in group P was significantly lower than that in group D?P<0.05?.There was no significant difference between the two groups during the recovery period of anesthesia?P>0.05?,but drowsiness was more common in group D than in group P?P<0.05?.No significant complications and adverse reactions were found in the two groups during the 24-hour follow-up?P>0.05?.The satisfaction of patients and doctors to the two groups of anesthetic methods was higher in group D than that in group P,but there was no statistical significance?P>0.05?.ConclusionsThis study demonstrated that dexmetomidine?initial dose 2ug/kg,maintenance dose2ug/kg/h?is safe and effective in ERCP.Compared with propofol,dexmetomidine had less adverse effect on respiration,and is safe for airway management,with stable hemodynamics during operation.It reduced the number and time of artificial intervention by anesthesiologist,and did not prolong the recovery time.