Efficacy of different doses of dexmedetomidine combined with propofol for drug-induced sleep endoscopy in patients with snoring

Abstract

Objective To evaluate the efficacy of different doses of dexmedetomidine combined with propofol for drug-induced sleep endoscopy(DISE)in the patients with snoring. Methods Sixty patients with snoring, aged 24-62 yr, with body mass index of 24-37 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective DISE, were randomly divided into either group Ⅰor groupⅡ, with 30 patients in each group.In Ⅰ and Ⅱ groups, dexmedetomidine was infused over 10 min in a loading dose of 0.4 and 0.8 μg/kg, respectively, followed by an infusion of 0.4 μg·kg-1·h-1.At 15 min of dexmedetomidine infusion, propofol was given by target-controlled infusion with the initial target plasma concentration(Cp)of 1.0 μg/ml.At 2 min after the target effect-site and plasma concentrations were balanced, the Cp of propofol was increased/decreased by 0.2 μg/ml to maintain the Cp of propofol stable during DISE.Bispectral index(BIS)value was recorded before anesthesia(T1), at 10 and 15 min of dexmedetomidine infusion(T2, 3), at 2 min after the target effect-site and plasma concentrations were balanced(T4), at the beginning of DISE(T5), when the fiberoptic laryngoscope was placed at the site of oropharynx(T6), at the end of DISE(T7), at emergence(T8), and while discharge from the examination room(T9). Richmond Agitation Sedation Scale(RASS)scores were recorded at T1-4.Sleep was recorded within 15 min of dexmedetomidine infusion.The emergence time, discharge time, and anesthetics-related adverse events were recorded. Results All the patients completed DISE successfully.BIS values were maintained at 75-90, and RASS scores ≤ 4 during dexmedetomidine infusion.BIS values were maintained at 65-75 during DISE.Compared with groupⅠ, BIS values were significantly decreased at T4, and RASS scores were significantly increased at T2-4, the sleep rate was significantly increased within 15 min of dexmedetomidine infusion, the Cp of propofol was significantly decreased during DISE, the emergence time was significantly prolonged(P 0.05). Conclusion Dexmedetomidine infused at 0.4 μg·kg-1·h-1 after infusion of a loading dose of 0.8 μg/kg combined with propofol provides better efficacy for DISE in the patients with snoring. Key words: Dexmedetomidine; Propofol; Snoring; Endoscopy; Sleep