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Dexmedetomidine is safe and reduces the additional dose of midazolam for sedation during endoscopic retrograde cholangiopancreatography in very elderly patients

Authors :
Osamu Inatomi
Takayuki Imai
Takehide Fujimoto
Kenichiro Takahashi
Yoshihiro Yokota
Noriaki Yamashita
Hiroshi Hasegawa
Atsushi Nishida
Shigeki Bamba
Mitsushige Sugimoto
Akira Andoh
Source :
BMC Gastroenterology, Vol 18, Iss 1, Pp 1-6 (2018)
Publication Year :
2018
Publisher :
BMC, 2018.

Abstract

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Dexmedetomidine, a highly selective α2-adrenoceptor agonist with sedative activity and minimal effects on respiration, has recently been widely used among patients in the intensive care unit. However, its use in endoscopic procedures in very elderly patients is unclear. In this study, we retrospectively investigated the safety and efficacy of dexmedetomidine sedation during ERCP. Methods The study included 62 very elderly patients (aged over 80 years) who underwent ERCP from January 2014, with sedation involving dexmedetomidine (i.v. infusion at 3.0 μg/kg/h over 10 min followed by continuous infusion at 0.4 μg/kg/h) along with midazolam. For comparison, the study included 78 patients who underwent ERCP before January 2014, with midazolam alone. We considered additional administration of midazolam as needed to maintain a sedation level of 3–4, according to the Ramsay sedation scale. The outcome measures were amount of midazolam, adverse events associated with sedation, and hemodynamics. Results The incidence of decreased SpO2 and median dose of additional midazolam were significantly lower in the dexmedetomidine group than in the conventional group. The minimum systolic blood pressure and minimum heart rate during and after examination was significantly lower in the dexmedetomidine group than in the conventional group. However, serious acute heart failure or arrhythmia was not noted. Conclusions Dexmedetomidine can decrease the incidence of respiratory complications and the total dose of other sedative agents. It can be used as an alternative to conventional methods with midazolam for adequate sedation during ERCP in very elderly patients.

Details

Language :
English
ISSN :
1471230X
Volume :
18
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Gastroenterology
Publication Type :
Academic Journal
Accession number :
edsdoj.23b37cc9d8144f96b2b1114af8a0c9fe
Document Type :
article
Full Text :
https://doi.org/10.1186/s12876-018-0897-5