Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection
Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection
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DOI：
10.1111/jgh.15417
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发表时间：
2021-02-04
影响因子：
4.1
通讯作者：
Nakajima, Atsushi
中科院分区：
文献类型：
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作者：
Ashikari, Keiichi;Nonaka, Takashi;Nakajima, Atsushi
背景与目的在浅表性食管癌的内镜下粘膜下剥离术中，患者有时会出现身体运动，这可能导致手术中断。异丙酚和右美托咪定最近被发现是内镜下粘膜下解剖有用的镇静剂。本研究探讨了异丙酚联合右美托咪定是否能抑制食管内镜下粘膜下剥离患者的身体运动，并将其与单独使用异丙酚的镇静进行了比较。方法前瞻性双盲随机对照试验。前瞻性纳入在横滨市立大学医院行食管内镜粘膜下剥离术的浅表性食管癌患者，随机分为异丙酚组和异丙酚+右美托咪定组。主要终点是躁动的发生率。次要终点为满意度评分、异丙酚维持剂量和异丙酚抢救注射次数。结果共纳入66例患者，其中异丙酚组33例，联合用药组33例。联合用药组躁动发生率明显低于异丙酚组（3.0% vs 27.3%, P = 0.02）。联合组内窥镜医师满意度评分明显高于单用组，异丙酚维持剂量明显低于单用组（3.0% vs 18.2%, P < 0.001），异丙酚抢救注射次数明显低于单用组（P < 0.001）。联合用药组心动过缓发生率明显高于对照组（30.3% vs 3.0%, P < 0.01），但未发生严重不良反应。结论异丙酚与右美托咪定联合应用具有良好的镇静效果，可有效抑制食管内镜下粘膜下夹层患者的身体运动。
Background and Aim During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone.Methods This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections.Results Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred.Conclusion The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.