Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of a Dexmedetomidine–Remifentanil Combination Compared with a Midazolam–Remifentanil Combination for Conscious Sedation During Therapeutic Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Randomized, Single-Blinded Preliminary Trial

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Dexmedetomidine as a conscious sedative exhibits both analgesia and respiratory sparing effects.

Aims

We evaluated and compared the sedative effect and the safety of a dexmedetomidine–remifentanil (DR) regimen with a midazolam–remifentanil (MR) combination during the endoscopic retrograde cholangio-pancreatography (ERCP) requiring conscious sedation.

Methods

One-hundred and ninety-eight patients were randomized and divided into two groups. A bolus of midazolam (0.05 mg kg−1) was injected intravenously for MR group, and dexmedetomidine (1 μg kg−1) was pumping for 10 min for DR group. Next, an initial loading dose of 1 μg kg−1 and 0.05–0.2 μg kg−1 min−1 of remifentanil was administered in all patients. Hemodynamic and respiratory changes, Ramsay Sedation Scale, Visual Analogue Scale, endoscopist and patient satisfaction were assessed. Furthermore, adverse events as well as recovery time and discharge time were rated.

Results

Patient satisfaction scores were significantly higher in the DR group compared with MR group. The occurrence of desaturation was statistically higher, and the operation time was longer in the MR group. Although no statistically significant values could be determined between the two groups about amnesia and need of additional drug, the DR group was found to require a significantly reduced amount of extra midazolam. Furthermore, nausea during catheterization of oropharynx was found to be more pronounced in the DR group.

Conclusions

The dexmedetomidine–remifentanil protocol provided a parallel sedative efficacy and improved respiratory sparing effects. The higher patient satisfaction scores potentially offer a more reproducible ERCP quality. Adding dexmedetomidine to remifentanil can be used safely as a conscious sedation method during ERCP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mazzon D, Germanà B, Poole D, et al. Conscious sedation during endoscopic retrograde colangiopancreatography: implementation of SIED-SIAARTI-ANOTE guidelines in Belluno Hospital. Minerva Anestesiol. 2005;71:101–109.

    PubMed  CAS  Google Scholar 

  2. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of IV dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125–1133.

    Article  PubMed  CAS  Google Scholar 

  3. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382–394.

    Article  PubMed  CAS  Google Scholar 

  4. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical subject requiring intensive care. Crit Care Med. 2000;4:302–308.

    CAS  Google Scholar 

  5. Goksu S, Arik H, Demiryurek S, et al. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008;25:22–28.

    Article  PubMed  CAS  Google Scholar 

  6. Dere K, Sucullu I, Budak ET, et al. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol. 2010;27:648–652.

    Article  PubMed  CAS  Google Scholar 

  7. Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc. 2008;67:651–659.

    Article  PubMed  Google Scholar 

  8. Chen WX, Lin HJ, Zhang WF, et al. Sedation and safety of propofol for therapeutic endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2005;4:437–440.

    PubMed  CAS  Google Scholar 

  9. Lee BS, Ryu J, Lee SH, et al. Midazolam with meperidine and dexmedetomidine versus midazolam with meperidine for sedation during ERCP: prospective, randomized, double-blinded trial. Endoscopy. 2014;46:291–298.

    Article  PubMed  Google Scholar 

  10. Nishizawa T, Suzuki H, Matsuzaki J, Kanai T, Yahagi N. Propofol versus traditional sedative agents for endoscopic submucosal dissection: a systematic review. Dig Endosc. 2014;26:701–706.

    Article  PubMed  Google Scholar 

  11. Habib NE, Mandour NM, Balmer HG. Effects of midazolam on anxiety level and pain perception in cataract surgery with topical anesthesia. J Cataract Refract Surg. 2004;30:437–443.

    Article  PubMed  Google Scholar 

  12. Lee SP, Sung IK, Kim JH, et al. Comparison of dexmedetomidine with on-demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor. J Dig Dis. 2015;16:377–384.

    Article  PubMed  CAS  Google Scholar 

  13. Egan TD, Lemmens HJ, Fiset P, et al. The pharmacokinetics of the new shortacting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology. 1993;79:881–892.

    Article  PubMed  CAS  Google Scholar 

  14. Kapila A, Glass PS, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology. 1995;83:968–975.

    Article  PubMed  CAS  Google Scholar 

  15. Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology. 1993;79:893–903.

    Article  PubMed  CAS  Google Scholar 

  16. Kim N, Yoo YC, Lee SK, Kim H, Ju HM, Min KT. Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection. World J Gastroenterol. 2015;21:3671–3678.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Kilic N, Sahin S, Aksu H, et al. Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. Eurasian J Med. 2011;43:13–17.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Alhashemi JA. Dexmedetomidine versus midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth. 2006;96:722–726.

    Article  PubMed  CAS  Google Scholar 

  19. Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia. Anesthesiology. 1991;74:581–605.

    Article  PubMed  CAS  Google Scholar 

  20. Kuhar MJ, Unnerstall JR. Mapping receptors for alpha 2-agonists in the central nervous system. J Cardiovasc Pharmacol. 1984;6:S536–S542.

    Article  PubMed  Google Scholar 

  21. Von Delius S, Salletmaier H, Meining A, et al. Bispectral index monitoring of midazolam and propofol sedation during endoscopic retrograde cholangiopancreatography: a randomized clinical trial (the EndoBIS study). Endoscopy. 2012;44:258–264.

    Article  Google Scholar 

  22. Mukhopadhyay S, Niyogi M, Sarkar J, Mukhopadhyay BS, Halder SK. The dexmedetomidine “augmented” sedatoanalgesic cocktail: an effective approach for sedation in prolonged endoscopic retrograde cholangiopancreatography. J Anaesthesiol Clin Pharmacol. 2015;31:201–206.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Jang SY, Park HG, Jung MK, et al. Bispectral index monitoring as an adjunct to nurse-administered combined sedation during endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2012;18:6284–6289.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. el-Bitar N, Sfeir S. Evaluation of remifentanil in endoscopic retrograde cholangio-pancreatography. Middle East J Anaesthesiol. 2006;18:1209–1216.

    PubMed  CAS  Google Scholar 

  25. Zhang J, Huang Y, Li Z, Li J, Liu K, Li C. Sedation and use of analgesics in endoscopic retrograde cholangiopancreatography: a double-blind comparison study of meperidine/midazolam, remifentanil/midazolam, and remifentanil alone. Int J Clin Pharmacol Ther. 2016;54:872–879.

    Article  PubMed  CAS  Google Scholar 

  26. Goyal R, Hasnain S, Mittal S, Shreevastava S. A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol–fentanyl combination for ERCP. Gastrointest Endosc. 2016;83:928–933.

    Article  PubMed  Google Scholar 

  27. Ramkiran S, Iyer SS, Dharmavaram S, Mohan CV, Balekudru A, Kunnavil R. BIS targeted propofol sparing effects of dexmedetomidine versus ketamine in outpatient ERCP: a prospective randomised controlled trial. J Clin Diagn Res. 2015;9:UC07-12.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, 210011, China

    Zhiqiang Lu, Wenyuan Li & Huiyu Chen

  2. Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Yanning Qian

Authors
  1. Zhiqiang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenyuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huiyu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanning Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZL wrote the manuscript; WL was responsible for statistical analysis; YQ and HC contributed to critical revision of the manuscript.

Corresponding author

Correspondence to Yanning Qian.

Ethics declarations

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, Z., Li, W., Chen, H. et al. Efficacy of a Dexmedetomidine–Remifentanil Combination Compared with a Midazolam–Remifentanil Combination for Conscious Sedation During Therapeutic Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Randomized, Single-Blinded Preliminary Trial. Dig Dis Sci 63, 1633–1640 (2018). https://doi.org/10.1007/s10620-018-5034-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5034-3

Keywords

Search

Navigation