Abstract
BackgroudAlthough propofol and dexmedetomidine have been widely used for monitored anesthesia care, their adverse effects necessitate the search for better methods. Therefore, we performed this randomized controlled trial to evaluate the combined use of propofol and dexmedetomidine.MethodsEighty-seven adult patients undergoing hand surgery under brachial plexus block were randomly allocated to receive 1.6 μg/ml of the target effect site concentration of propofol (P group) and infusion of 0.4 μg/kg/h dexmedetomidine following a loading dose of 1.0 μg/kg for 10 min (D group). The M group received a half-dose of both drugs simultaneously. The maintenance dose was adjusted to maintain an Observer Assessment of Alertness/Sedation score of 3. Cardiorespiratory variables, adverse effects, and drug efficacy were observed.ResultsThe significantly higher mean arterial pressure (mmHg) in the D group [P group 86.9 (12.6), D group 96.0 (12.2), M group 85.6 (10.6), p = 0.004)] and a significantly higher heart rate (beat/min) in the P group were observed [P group 67.3 (9.0), D group 57.8 (6.9), M group 59.2 (7.4), p < 0.001)]. The M group had a significant lower incidence of airway obstruction (p < 0.001) and the D group had a higher incidence of bradycardia requiring atropine (p = 0.001). The P group had higher incidences of hypoxia (p = 0.001), spontaneous movement (p < 0.001) and agitation (p = 0.001). The satisfaction scores of the patients (p = 0.007) and surgeon (p < 0.001) were higher in the M group. Onset time was significantly longer in the D group (p < 0.001).ConclusionsThe combined use of propofol and dexmedetomidine provided cardiovascular stability with decreased adverse effects. Additionally, it led to a similar onset time of propofol and achieved higher satisfaction scores.Trial registrationKCT0001284. Retrospectively registered 25 November 2014.
Highlights
Monitored anesthesia care (MAC) has been used to provide sedation, comfort, memory loss and relief from anxiety during therapeutic or diagnostic procedures with sedation and analgesia [1, 2]
In P group, two patients showed so excessive agitation that general anesthesia was needed and in D group, one patient was excluded from analysis because the sedation level of the patient was deeper than the designated state per our protocol
Changes in hemodynamic and respiratory variables The reduction of mean arterial pressure in the D group was significantly less than other groups [P group 86.9 (12.6), D group 96.0 (12.2), M group 85.6 (10.6), p = 0.004)] (Fig. 2a) and the reduction of heart rate in the P group was significantly less than other groups [P group 67.3 (9.0), D group 57.8 (6.9), M group 59.2 (7.4), p < 0.001)] (Fig. 2b)
Summary
Monitored anesthesia care (MAC) has been used to provide sedation, comfort, memory loss and relief from anxiety during therapeutic or diagnostic procedures with sedation and analgesia [1, 2]. Because respiratory depression is associated with the most serious patient injuries during MAC [3], the optimal state of MAC is the maintenance of sedation and normal cardiovascular functions without severe respiratory depression and airway obstruction. The capability to rapidly modulate the depth. Among these drugs, propofol provides antiemetic properties, high quality sedation, and rapid onset and recovery times [4, 5]. Propofol has some adverse effects such as severe respiratory depression and hypotension, which highlight the need to find better drugs for MAC [7, 8].
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