title: Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection.
abstract: OBJECTIVE
  To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil.
  
  
  METHODS
  Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidine-remifentanil (DR) group or a propofol-remifentanil (PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer's Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety.
  
  
  RESULTS
  Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group ("very easy" 24.1% vs 56.7%, P = 0.010), gastric motility was more suppressed in the DR group ("no + mild" 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group ("very good + good" 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477).
  
  
  CONCLUSIONS
  The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Namo
authors.initials: N
authors.lastname: Kim
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Yoo
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hyunzu
authors.initials: H
authors.lastname: Kim
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hyang Mi
authors.initials: HM
authors.lastname: Ju
authors.affiliation: Namo Kim, Young-Chul Yoo, Hyunzu Kim, Hyang Mi Ju, Kyeong Tae Min, Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Kyeong Tae
authors.initials: KT
authors.lastname: Min
mesh_terms: D000368:Aged; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D000077208:Remifentanil; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil; D015742:Propofol
keywords: Dexmedetomidine; Efficacy; Endoscopic submucosal dissection; Peristalsis; Safety
references.citation: Anesthesiology. 2002 Apr;96(4):1004-17
references.pmid: 11964611
references.citation: Clin Gastroenterol Hepatol. 2010 Feb;8(2):137-42
references.pmid: 19607937
references.citation: BMC Gastroenterol. 2013;13:176
references.pmid: 24377675
references.citation: Diagn Ther Endosc. 2014;2014:248097
references.pmid: 24723747
references.citation: Eur J Anaesthesiol. 2010 Jul;27(7):648-52
references.pmid: 20531094
references.citation: J Res Med Sci. 2013 Feb;18(2):107-14
references.pmid: 23914211
references.citation: Dig Endosc. 2013 Mar;25 Suppl 1:79-85
references.pmid: 23406354
references.citation: Can J Gastroenterol. 2008 May;22(5):457-9
references.pmid: 18478130
references.citation: Surg Endosc. 2014 Jan;28(1):100-7
references.pmid: 23959522
references.citation: Surg Endosc. 2013 Aug;27(8):2760-7
references.pmid: 23389074
references.citation: J Clin Anesth. 1995 Feb;7(1):89-91
references.pmid: 7772368
references.citation: Dig Endosc. 2011 Apr;23(2):176-81
references.pmid: 21429025
references.citation: Br J Anaesth. 2011 Apr;106(4):522-7
references.pmid: 21307009
references.citation: J Gastroenterol. 2010 Aug;45(8):831-7
references.pmid: 20228999
references.citation: Dig Endosc. 2014 Jul;26(4):515-24
references.pmid: 24354404
references.citation: Anesthesiology. 2002 Jul;97(1):96-101
references.pmid: 12131109
references.citation: J Clin Psychopharmacol. 1990 Aug;10(4):244-51
references.pmid: 2286697
references.citation: Clin Gastroenterol Hepatol. 2009 Feb;7(2):156-62
references.pmid: 18930167
references.citation: Endoscopy. 2012 Jun;44(6):584-9
references.pmid: 22638779
references.citation: Eur J Anaesthesiol. 2006 Aug;23(8):700-4
references.pmid: 16805936
references.citation: Aliment Pharmacol Ther. 2010 Aug;32(3):425-42
references.pmid: 20456310
references.citation: Surg Endosc. 2009 May;23(5):1125-9
references.pmid: 19301072
references.citation: Endoscopy. 2012 Jun;44(6):556-64
references.pmid: 22638778
references.citation: Gastrointest Endosc. 1999 Jun;49(6):677-83
references.pmid: 10343208
references.citation: Br J Anaesth. 1998 Jan;80(1):63-7
references.pmid: 9505780
references.citation: Gastrointest Endosc. 2011 May;73(5):932-41
references.pmid: 21353674