title: Intranasal dexmedetomidine in combination with patient-controlled sedation during upper gastrointestinal endoscopy: a randomised trial.
abstract: BACKGROUND
  Sedation using intranasal dexmedetomidine is a convenient and well-tolerated technique. This study evaluated the sedative efficacy of intranasal dexmedetomidine in combination with patient-controlled sedation (PCS) for upper gastrointestinal endoscopy.
  
  
  METHODS
  In this double-blind, randomised, controlled trial, 50 patients received either intranasal dexmedetomidine 1.5 μg/kg (dexmedetomidine group) or intranasal saline (placebo group) 1 h before the procedure. PCS with propofol and alfentanil was provided for rescue sedation. Additional sedative consumption, perioperative sedation scores using Observer's Assessment of Alertness/Sedation (OAA/S) scale, recovery, vital signs, adverse events and patient satisfaction were assessed.
  
  
  RESULTS
  Total consumption of PCS propofol and alfentanil was significantly less in the dexmedetomidine than placebo group with a mean difference of -13.8 mg propofol (95% confidence interval -27.3 to -0.3) and -34.5 μg alfentanil (95% confidence interval -68.2 to -0.7) at the completion of the procedure (P = 0.044). Weighted areas under the curve (AUCw ) of OAA/S scores were significantly lower in the dexmedetomidine group before, during and after procedures (P < 0.001, P = 0.024 and P = 0.041 respectively). AUCw of heart rate and systolic blood pressure were also significantly lower during the procedure (P = 0.007 and P = 0.022 respectively) with dexmedetomidine. There was no difference in recovery, side effects or satisfaction.
  
  
  CONCLUSIONS
  Intranasal dexmedetomidine with PCS propofol and alfentanil confers deeper perioperative clinical sedation with significantly less use of additional sedatives during upper gastrointestinal endoscopy.
authors.affiliation: Department of Anaesthesiology, The University of Hong Kong, Hong Kong.
authors.forename: C W
authors.initials: CW
authors.lastname: Cheung
authors.forename: Q
authors.initials: Q
authors.lastname: Qiu
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.forename: K M
authors.initials: KM
authors.lastname: Chu
authors.forename: M G
authors.initials: MG
authors.lastname: Irwin
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D015760:Alfentanil; D012965:Sodium Chloride; D020927:Dexmedetomidine; D015742:Propofol