title: Comparison of three sedation regimens for drug-induced sleep endoscopy.
abstract: OBJECTIVE
  Drug-induced sleep endoscopy (DISE) allows for direct airway observation in patients with obstructive sleep apnea. This study compared the safety profiles and efficacies of three regimens for DISE.
  
  
  METHODS
  Sixty-six patients were randomly assigned to receive propofol alone (n = 22), a propofol-remifentanil combination (n = 22), or a dexmedetomidine-remifentanil combination (n = 22). Remifentanil was infused at a concentration of 1.5 ng·ml(-1) in the propofol-remifentanil and dexmedetomidine-remifentanil groups, whereas saline was infused in the propofol group. The propofol and propofol-remifentanil groups received propofol at a starting concentration of 1.0 μg·ml(-1), then 0.1 μg·ml(-1) increments at 5 min intervals. The dexmedetomidine-remifentanil group received 1.0 μg·kg(-1) loading dose of dexmedetomidine for 10 min and then 0.2 μg·kg(-1)·h(-1) increments at 5 min intervals.
  
  
  RESULTS
  The incidence of oxygen desaturation was significantly higher in the propofol-remifentanil group compared with that of the dexmedetomidine-remifentanil group (77 vs. 45%, respectively, P = 0.024). Even with a maximum dose of dexmedetomidine (1.4 μg·kg(-1)·h(-1)), 50% of the dexmedetomidine-remifentanil group did not reach sufficient sedation and required additional propofol. Cough reflex occurred in five patients of propofol group and in neither of the other groups (P = 0.004).
  
  
  CONCLUSIONS
  The propofol-remifentanil combination was associated with a higher incidence of desaturation. The dexmedetomidine-remifentanil combination was associated with inadequate sedation in one half of the patients, even though it produced less respiratory depression. Addition of remifentanil reduced the cough reflex.
authors: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors: Jin Sun
authors: JS
authors: Cho
authors: Sara
authors: S
authors: Soh
authors: Eun Jung
authors: EJ
authors: Kim
authors: Hyung-ju
authors: HJ
authors: Cho
authors: Seokyung
authors: S
authors: Shin
authors: Hye Jin
authors: HJ
authors: Kim
authors: Bon-Nyeo
authors: BN
authors: Koo
mesh_terms: D000328:Adult; D000403:Airway Resistance / Q000502:physiology*; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D017286:Polysomnography / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D000077208:Remifentanil; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*
chemical_list: D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol
references: Hosp Pract (1995). 2012 Feb;40(1):186-92
references: 22406894
references: Anesthesiology. 1993 May;78(5):821-8
references: 8098191
references: Anaesthesia. 2011 May;66(5):368-72
references: 21443641
references: Eur J Anaesthesiol. 2010 Jul;27(7):648-52
references: 20531094
references: Eur Arch Otorhinolaryngol. 2007 Sep;264(9):1081-6
references: 17443336
references: Acta Otorhinolaryngol Ital. 2013 Dec;33(6):405-13
references: 24376297
references: Laryngoscope. 2001 Jan;111(1):175-6
references: 11192890
references: Int J Pediatr. 2012;2012:576719
references: 22518178
references: ScientificWorldJournal. 2014 Jan 16;2014:805013
references: 24558330
references: Sleep. 2011 Mar 01;34(3):283-91A
references: 21358845
references: Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39
references: 11991871
references: Clin Otolaryngol Allied Sci. 1991 Dec;16(6):559-62
references: 1782719
references: Eur Arch Otorhinolaryngol. 2011 Mar;268(3):457-62
references: 20811901
references: Anesth Analg. 2009 Apr;108(4):1157-60
references: 19299779
references: Laryngoscope. 2013 Jan;123(1):292-7
references: 23168682
references: Eur Arch Otorhinolaryngol. 2014 May;271(5):1311-9
references: 24196346
references: Am J Ther. 2010 Nov-Dec;17(6):586-95
references: 20535016
references: Eur Arch Otorhinolaryngol. 2014 Jan;271(1):181-7
references: 23665745
references: Otolaryngol Head Neck Surg. 2010 Feb;142(2):218-24
references: 20115978
references: J Neurosurg Anesthesiol. 2005 Apr;17(2):97-9
references: 15840996
references: Sleep Breath. 2013 Mar;17(1):63-8
references: 22270687
references: Br J Anaesth. 2012 Mar;108(3):503-11
references: 22174346
references: Am J Crit Care. 2014 Mar;23(2):160-5
references: 24585165
references: Anesth Analg. 2009 Dec;109(6):1811-5
references: 19923507
references: Anesthesiology. 2009 Jul;111(1):63-71
references: 19512872