THE COMPARISON OF DEXMEDETOMIDINE AND MIDAZOLAM USED FOR SEDATION OF PATIENTS UNDERGOING UPPER GASTROINTESTINAL ENDOSCOPY: A PROSPECTIVE COMPARATIVE STUDY
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Date
2022-03-21
Authors
Ibrahim Ghoul
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Abstract
Background: Endoscopic procedures are essential for diagnostic testing, examining, and treating a wide range of disorders like gastrointestinal tract blood loss, foreign object removal, and many other complicated procedures such as Endoscopic retrograde cholangiopancreatography. An endoscope is an irritating and painful procedure. during which patients should be anesthetized to avoid mobility, pain, coughing, gagging, and nausea. So, sufficient analgesia and sedation agents should be given and monitored with minimal side effects or complications. These agents can keep patients'response to pain and verbal stimuli without failing respiratory or cardiovascular function.
Objectives: The current study aims to compare and investigate the efficacy and safety of Midazolam versus Dexmedetomidine in terms of respiratory, hemodynamic, analgesia, sedation, patient satisfaction, endoscopist satisfaction, and adverse effects in patients undergoing upper endoscopy at An-Najah National University Hospital.
Methodology: A prospective observational study was performed on 68 patients (aged 18-60) undergoing upper endoscopy using theAmerican Society of Anesthesiologists (ASA) Physical Status Classification System (grades one and two). The study was conducted at An-Najah National University Hospital, Nablus-Palestine, between October 2021 and January 2022. All subjects received information about the purpose of the study, the study protocol, and the consent form was obtained from each subject.
Results: Regarding patient satisfaction, the Dexmedetomidine demonstrated much higher satisfaction, minor discomfort, and less anxiety than Midazolam with P<0.05. Regarding endoscopy specialists, the satisfaction, discomfort, gagging, retching, and technical difficulty showed that Dexmedetomidine outperformed the Midazolam with P<0.05. Dexmedetomidine patients recovered faster than Midazolam patients with p <0.05, Midazolam needs 2.4 ± 7.7 minutes to be sedated while Dexmedetomidine needs 9.5 ± 1.1 minutes , and this difference is significant since the p <0.05. Regarding side effects occurrence, Dexmedetomidine had fewer side effects than the Midazolam, but with no statistically significant difference. Regarding vital signs, there is no significant difference between Midazolam and Dexmedetomidine.
Conclusions: Dexmedetomidine outperformed Midazolam in recovery time, patient satisfaction, endoscopy specialist satisfaction, discomfort, anxiety, and retching; Dexmedetomidine appears to be a useful alternative to Midazolam for sedating patients during upper endoscopy because it is both safe and effective.
Keywords: Dexmedetomidine, Midazolam, sedation, upper endoscopy.