A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial.
BACKGROUND
Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracorporeal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure.


METHODS
Forty-six patients were randomly allocated into two groups to receive either dexmedetomidine or propofol for elective ESWL. Dexmedetomidine was infused at 6 microg x kg(-1) x h(-1) for 10 min followed by an infusion rate of 0.2 microg x kg(-1) x h(-1). Propofol was infused at 6 mg x kg(-1) x h(-1) for 10 min followed by an infusion of 2.4 mg x kg(-1) x h(-1). Fentanyl 1 microg/kg IV was given to all patients 10 min before ESWL. Pain intensity was evaluated with a visual analog scale at 5-min intervals during ESWL (10-35 min). Sedation was determined using the Observer's Assessment of Alertness/Sedation. The Observer's Assessment of Alertness/ Sedation scores and hemodynamic and respiratory variables were recorded regularly during ESWL (35 min) and up to 85 min after.


RESULTS
Forty patients were evaluated. Visual analog scale values with dexmedetomidine were significantly lower than those with propofol only at the 25-35 min assessments (P < 0.05). During sedation, the respiratory rate with dexmedetomidine was significantly slower but Spo2 was significantly higher than with propofol (P < 0.05). Other clinical variables were similar (P > 0.05).


CONCLUSIONS
A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.
Kaygusuz
Kenan
K
Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey. kaygusuz@cumhuriyet.edu.tr
Gokce
Gokhan
G
Gursoy
Sinan
S
Ayan
Semih
S
Mimaroglu
Caner
C
Gultekin
Yener
Y
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D016292:Procedural Sedation; D003243:Consciousness / Q000187:drug effects*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015656:Respiratory Mechanics / Q000187:drug effects; D016896:Treatment Outcome
D000700:Analgesics; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D005283:Fentanyl; D015742:Propofol