Evaluation of the application of dexmedetomidine for moderate sedation in endoscopic ultrasonography_West China Medical Journal

Authors：

TU Hong ¹ , WANG Xia ¹ , XIANG Shunju ² , CAI Li ² , HU Bing ³ , TANG Qinghua ³ ,  WANG Xiao ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Nursing, Sichuan University / Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Xiao, Email: 1490829116@qq.com

Keywords：

Endoscopic ultrasonography; Sedation; Application evaluation

DOI：

10.7507/1002-0179.202012050

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Objective To evaluate the application of dexmedetomidine for moderate sedation in patients undergoing endoscopic ultrasonography.Methods Patients who were planned to undergo endoscopic ultrasonography in West China Hospital of Sichuan University from February to June 2019 were randomly divided into dexmedetomidine group (trial group) and propofol group (control group). The basic conditions, success rate of endoscopic ultrasound diagnosis and treatment, sedation-related adverse events, implementation of airway management, postoperative comfort evaluation and endoscopic physician satisfaction score of the two groups were compared.Results A total of 120 patients were eventually enrolled, 60 in each group. There was no significant difference in the basic conditions of the two groups (P>0.05). The success rate of endoscopic ultrasound diagnosis and treatment in two groups were 100%. There was no significant difference in the incidence of bucking, apnea and bradycardia between the two groups (P>0.05). The incidence of hypotension (15.0% vs. 31.7%), hypoxemia (6.7% vs.20.0%) in the trial group was lower than those in the control group, the differences were statistically significant (P<0.05). The proportion of patients in the trial group who performed airway management was lower than that in the control group (1.7% vs. 28.3%), and the difference was statistically significant (P<0.05). There was no significant difference in postoperative pain score, the first time to get out of bed and postoperative 15-item quality of recovery questionnaire score between the two groups (P>0.05). The incidence of nausea and vomiting at 6 hours after operation (48.3% vs. 3.3%) and 24 hours after operation (10.0% vs. 0.0%) and the time required for recovery of gastrointestinal function ［(201.4±178.4) vs. (148.5±75.7) min］ in the trial group were higher than those in the control group (P<0.05). The median (the lower and upper quartile) of comfort score of patients and satisfaction score of endoscopic physicians were 8 (6, 10) and 8 (7, 9) in the trial group, respectively, and were 10 (9, 10) and 9 (8, 10) in the control group, with statistically significant differences (P<0.05).Conclusion Moderate sedation with dexmedetomidine could provide good sedative and analgesic effects in endoscopic ultrasonography. It has little effect on respiration and blood pressure, but the incidence of postoperative nausea and vomiting were higher than deep sedation with propofol. And patient comfort and endoscopic physician satisfaction also need to be improved.

Citation： TU Hong, WANG Xia, XIANG Shunju, CAI Li, HU Bing, TANG Qinghua, WANG Xiao. Evaluation of the application of dexmedetomidine for moderate sedation in endoscopic ultrasonography. West China Medical Journal, 2021, 36(3): 379-384. doi: 10.7507/1002-0179.202012050 Copy

1.	D’Souza SL, Holub JL, Pavic BT, et al. Multicenter evaluation of the utilization of endoscopic ultrasound. Dig Endosc, 2016, 28(7): 738-743.
2.	Campbell JA, Irvine AJ, Hopper AD. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?. World J Gastroenterol, 2017, 23(3): 560-562.
3.	郭培培, 金朝, 李心怡, 等. 纳布啡或芬太尼联合丙泊酚麻醉用于内镜超声检查术麻醉效果的比较. 临床与病理杂志, 2019, 39(11): 2407-2411.
4.	中华医学会消化内镜学分会, 中华医学会麻醉学分会. 中国消化内镜诊疗镇静/麻醉的专家共识意见. 中华消化杂志, 2014, 34(8): 505-512.
5.	陶宏, 严晓晴, 朱文忠, 等. 无痛超声内镜诊治过程中的麻醉管理. 中华消化内镜杂志, 2011, 28(7): 392-394.
6.	Cheriyan DG, Byrne MF. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. World J Gastroenterol, 2014, 20(18): 5171-5176.
7.	Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology, 2006, 104(2): 228-234.
8.	Huang R, Eisen GM. Efficacy, safety, and limitations in current practice of sedation and analgesia. Gastrointest Endosc Clin N Am, 2004, 14(2): 269-288.
9.	李雪迎. 等效性设计样本量估算−计数指标. 中国介入心脏病学杂志, 2016, 24(8): 447.
10.	Chen SH, Yuan TM, Zhang J, et al. Remimazolam tosilate in upper gastrointestinal endoscopy: a multicenter, randomized, non-inferiority, phase Ⅲ trial. J Gastroenterol Hepatol, 2021, 36(2): 474-481.
11.	Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol, 1990, 10(4): 244-251.
12.	Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology, 2013, 118(6): 1332-1340.
13.	Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth, 1995, 7(1): 89-91.
14.	Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: which to use?. Am J Emerg Med, 2018, 36(4): 707-714.
15.	Ardengh JC, Lopes CV, de Lima LF, et al. Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration. World J Gastroenterol, 2007, 13(22): 3112-3116.
16.	Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol, 2004, 99(4): 628-633.
17.	葛楠, 孙思予, 金震东. 中国内镜超声引导下细针穿刺临床应用指南. 中华消化内镜杂志, 2017, 34(1): 3-13.
18.	中华医学会消化内镜学分会麻醉协作组. 常见消化内镜手术麻醉管理专家共识. 临床麻醉学杂志, 2019, 35(2): 177-185.
19.	吴龙奇, 高宝峰, 李建华. 丙泊酚用于老年无痛胃镜检查患者328例不良反应. 中国老年学杂志, 2012, 32(19): 4293-4294.
20.	王加斌, 李鹏飞, 汤琪云. 右美托咪定用于经胃超声内镜检查中的镇痛、镇静效果. 江苏医药, 2016, 42(15): 1730-1731.
21.	Padiyara TV, Bansal S, Jain D, et al. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope, 2020, 130(1): 257-262.
22.	Berthon-Jones M, Sullivan CE. Ventilation and arousal responses to hypercapnia in normal sleeping humans. J Appl Physiol Respir Environ Exerc Physiol, 1984, 57(1): 59-67.
23.	Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 2004, 101(5): 1066-1076.
24.	Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol, 2011, 28(1): 3-6.
25.	Heuss LT, Inauen W. The dawning of a new sedative: propofol in gastrointestinal endoscopy. Digestion, 2004, 69(1): 20-26.
26.	Iirola T, Vilo S, Aantaa R, et al. Dexmedetomidine inhibits gastric emptying and oro-caecal transit in healthy volunteers. Br J Anaesth, 2011, 106(4): 522-527.
27.	李兆申, 邓小明, 孙涛, 等. 中国消化内镜诊疗镇静麻醉专家共识意见. 中国实用内科杂志, 2014, 34(8): 756-764.
28.	Eberl S, Preckel B, Bergman JJ, et al. Satisfaction and safety using dexmedetomidine or propofol sedation during endoscopic oesophageal procedures: a randomised controlled trial. Eur J Anaesthesiol, 2016, 33(9): 631-637.

1. D’Souza SL, Holub JL, Pavic BT, et al. Multicenter evaluation of the utilization of endoscopic ultrasound. Dig Endosc, 2016, 28(7): 738-743.
2. Campbell JA, Irvine AJ, Hopper AD. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?. World J Gastroenterol, 2017, 23(3): 560-562.
3. 郭培培, 金朝, 李心怡, 等. 纳布啡或芬太尼联合丙泊酚麻醉用于内镜超声检查术麻醉效果的比较. 临床与病理杂志, 2019, 39(11): 2407-2411.
4. 中华医学会消化内镜学分会, 中华医学会麻醉学分会. 中国消化内镜诊疗镇静/麻醉的专家共识意见. 中华消化杂志, 2014, 34(8): 505-512.
5. 陶宏, 严晓晴, 朱文忠, 等. 无痛超声内镜诊治过程中的麻醉管理. 中华消化内镜杂志, 2011, 28(7): 392-394.
6. Cheriyan DG, Byrne MF. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. World J Gastroenterol, 2014, 20(18): 5171-5176.
7. Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology, 2006, 104(2): 228-234.
8. Huang R, Eisen GM. Efficacy, safety, and limitations in current practice of sedation and analgesia. Gastrointest Endosc Clin N Am, 2004, 14(2): 269-288.
9. 李雪迎. 等效性设计样本量估算−计数指标. 中国介入心脏病学杂志, 2016, 24(8): 447.
10. Chen SH, Yuan TM, Zhang J, et al. Remimazolam tosilate in upper gastrointestinal endoscopy: a multicenter, randomized, non-inferiority, phase Ⅲ trial. J Gastroenterol Hepatol, 2021, 36(2): 474-481.
11. Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol, 1990, 10(4): 244-251.
12. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology, 2013, 118(6): 1332-1340.
13. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth, 1995, 7(1): 89-91.
14. Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: which to use?. Am J Emerg Med, 2018, 36(4): 707-714.
15. Ardengh JC, Lopes CV, de Lima LF, et al. Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration. World J Gastroenterol, 2007, 13(22): 3112-3116.
16. Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol, 2004, 99(4): 628-633.
17. 葛楠, 孙思予, 金震东. 中国内镜超声引导下细针穿刺临床应用指南. 中华消化内镜杂志, 2017, 34(1): 3-13.
18. 中华医学会消化内镜学分会麻醉协作组. 常见消化内镜手术麻醉管理专家共识. 临床麻醉学杂志, 2019, 35(2): 177-185.
19. 吴龙奇, 高宝峰, 李建华. 丙泊酚用于老年无痛胃镜检查患者328例不良反应. 中国老年学杂志, 2012, 32(19): 4293-4294.
20. 王加斌, 李鹏飞, 汤琪云. 右美托咪定用于经胃超声内镜检查中的镇痛、镇静效果. 江苏医药, 2016, 42(15): 1730-1731.
21. Padiyara TV, Bansal S, Jain D, et al. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope, 2020, 130(1): 257-262.
22. Berthon-Jones M, Sullivan CE. Ventilation and arousal responses to hypercapnia in normal sleeping humans. J Appl Physiol Respir Environ Exerc Physiol, 1984, 57(1): 59-67.
23. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 2004, 101(5): 1066-1076.
24. Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol, 2011, 28(1): 3-6.
25. Heuss LT, Inauen W. The dawning of a new sedative: propofol in gastrointestinal endoscopy. Digestion, 2004, 69(1): 20-26.
26. Iirola T, Vilo S, Aantaa R, et al. Dexmedetomidine inhibits gastric emptying and oro-caecal transit in healthy volunteers. Br J Anaesth, 2011, 106(4): 522-527.
27. 李兆申, 邓小明, 孙涛, 等. 中国消化内镜诊疗镇静麻醉专家共识意见. 中国实用内科杂志, 2014, 34(8): 756-764.
28. Eberl S, Preckel B, Bergman JJ, et al. Satisfaction and safety using dexmedetomidine or propofol sedation during endoscopic oesophageal procedures: a randomised controlled trial. Eur J Anaesthesiol, 2016, 33(9): 631-637.

West China Medical Journal

Evaluation of the application of dexmedetomidine for moderate sedation in endoscopic ultrasonography

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