Dexmedetomidine impairs success of patient-controlled sedation in alcoholics during ERCP: a randomized, double-blind, placebo-controlled study.
BACKGROUND
There is a lack of studies about procedural sedation of alcoholics. Dexmedetomidine is recommended for procedural sedation and reported effective for alcohol withdrawal. We evaluated the suitability of dexmedetomidine for sedation of alcoholics during endoscopic retrograde cholangiopancreatography (ERCP).


METHODS
Fifty patients with chronic alcoholism scheduled for elective ERCP were randomized 1:1 to receive dexmedetomidine (Dex group) (loading dose 1 μg kg(-1) over 10 min, followed by constant intravenous infusion 0.7 μg kg(-1) h(-1)) or saline placebo (P group). Patient-controlled sedation with propofol-alfentanil was used by patients as a rescue method. Sedation was considered as successful if no intervention of an anesthesiologist was needed. Consumption of sedatives was registered, and sedation levels and vital signs were monitored.


RESULTS
Dexmedetomidine alone was insufficient in all patients. The mean ± SD consumption of propofol was 159 ± 72 mg in the P group, and 116 ± 61 mg in the Dex group (p = 0.028). Sedation was successful in 19 of 25 (76 %) patients in the Dex group and in all patients in the P group (p = 0.022). The incidence of sedation adverse events did not differ between the groups. Dexmedetomidine was associated with delayed recovery.


CONCLUSIONS
Patient-controlled sedation with propofol and alfentanil but not dexmedetomidine can be recommended for sedation of alcoholics during ERCP.
Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PL 340, 00029 HUS, Helsinki, Finland. maxim.mazanikov@hus.fi
Max
M
Mazanikov
Marianne
M
Udd
Leena
L
Kylänpää
Harri
H
Mustonen
Outi
O
Lindström
Jorma
J
Halttunen
Reino
R
Pöyhiä
D000437:Alcoholism / Q000150:complications*; D015760:Alfentanil; D018686:Anesthetics, Intravenous; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D015742:Propofol; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015760:Alfentanil; D020927:Dexmedetomidine; D015742:Propofol