title: Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam.
abstract: OBJECTIVE
  Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects.
  
  
  METHODS
  Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3-4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2-0.7 mcg/kg/hr, titrated to achieve an RSS of 3-4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9-10. Patient heart rates, arterial pressure and pain were evaluated.
  
  
  RESULTS
  Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p<0.05). There was no statistical difference in arterial pressure, RSS, MMSE or respiratory rate between the two groups. Coughing, nausea and vomiting occurred in 3 patients in Group M (12%), whereas no patient in Group D experienced these symptoms. The procedure elicited a gag response in 7 patients in Group M (28%) and in 4 patients in Group D (16%), with no significant difference between groups (p>0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05).
  
  
  CONCLUSIONS
  The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam.
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Kilic
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Sukran
authors.initials: S
authors.lastname: Sahin
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Hale
authors.initials: H
authors.lastname: Aksu
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Belgin
authors.initials: B
authors.lastname: Yavascaoglu
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Gurbet
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Turker
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Asli Guler
authors.initials: AG
authors.lastname: Kadioglu
keywords: Conscious sedation; Dexmedetomidine; ERCP; Midazolam