Efficacy and Safety of Dexmedetomidine for Conscious Sedation During Endoscopic Submucosal Dissection

Abstract

Introduction: Although diazepam DZP and pentazocine Hydrochloride (PTZ) is widely used for sedation during ESD in Japan, there are frequent cases found where the total amount of DZP usage is quite large due to ineffectiveness of sedation. Recently dexmedetomidine (DEX) has become used for sedation during ESD in Japan. DEX has an advantage over DZP in that it does not cause respiratory depression. Therefore, also in our institution DEX has been introduced for sedation during ESD since 2014. In the present study we aimed to investigate the efficacy and safety of DEX for sedation during ESD. Methods: We checked our electronic medical records and extracted 114 cases of ESD between 19th March 2014 and 7th April 2016. These 114 cases were divided into two groups: Group A DEX DPZ and PTZ used concomitantly; Group B, DPZ and PTZ used (without DEX). As the indicator of sedative effectiveness, we investigated the number of body movement which required additional administration of DPZ or PTZ. And we checked adverse events during sedation, such as bradycardia. Results: There were 80 cases extracted in group A, and 34 cases in group B. In group A, the number of body movement was significantly fewer than in group B (A 1.14/h, B 1.18/h). Moreover, the incidence of nausea or vomiting during or three hours after ESD was significantly lower in group A than in group B (2.5% vs 23%, P< 0.001). Whereas, low blood pressure sBP < 80mmHg or bradycardia < 60bpm occurred more frequently in group A than in group B (35% and 28% vs 2% and 0%, respectively; P < 0.001). In 6 cases of low blood pressure we required ephedrine hydrochloride injection. The rest cases of low blood pressure (23 cases) and all the bradycardia cases recovered spontaneously after the end of DEX injection. Conclusion: We concluded that DEX is effective in that it can reduce the number of body movement compared to a DPZ/PTZ method. Although low blood pressure and bradycardia are important adverse events related to DEX, it can be usually managed safely. DEX should be recommended for a sedative agent for ESD.