Comparison of Dexmedetomidine-Propofol and Fentanyl-Propofol for Monitored Anesthesia Care (MAC). A prospective randomized study in lower GI endoscopies in paediatric age group.

Abstract

Introduction The purpose of sedation and analgesia is to relieve patient anxiety and discomfort and improve the outcome of the GI endoscopic procedure. The objective is to eva- luate and compare the clinical efficacy and safety of Dexmedetomidine + Propofol (DP) and Fentanyl + Pro- pofol (FP) sedation for proclaiming a better drug regime in pediatric lower GI endoscopic procedures. Materials and Methods This prospective, randomized double blind study inclu- ded hundred pediatric patients, of ASA I–II, aged between 7 to 16 years and were randomly allocated to either Dexmedetomidine and Propofol (DP) or Fentanyl and Propofol (FP) groups. The study group received either Dexmedetomidine 1μg /kg over 10 minutes in DP group or Fentanyl 1μg/kg slow IV bolus in FP group for sedation induc- tion followed by Propofol (50μg/kg/min) for maintai- nence (± Propofol rescue doses 0.5mg/kg were admini- stered if patients showed discomfort) in both groups. Results The two groups were comparable in terms of age, weight, sex distribution, ASA status, diagnosis, the pro- cedure performed and baseline hemodynamic and respi- ratory parameters. The mean heart rate, systolic and diastolic arterial pres- sure during procedure were lower in the DP group as compared to FP group and difference was statistically significant (P < 0.05). Respiratory rate and SpO2 were lower in FP group. Higher Ramsay sedation scores were observed in DP group. The mean recovery time (DP vs FP, 8.7 vs 10.56 mins) and length of stay in recovery (DP vs FP, 12.9 vs 15.14mins) was lesser in DP groupand the difference was statistically significant (P < 0.05). The average number of rescue doses of Propofol used during the procedure were significantly less in DP group as compared to the FP group (DP vs FP, 1.84 ± 0.76 vs 3.72 ± 1.16, P Value <0.0001). The adequacy of analgesia in patients of both groups was assessed by Wong Baker Faces Pain Rating Scale and was comparable. A higher percentage of operator satisfaction was observed in patients who underwent co- lonoscopy in DP group Conclusion Dexmedetomidine-Propofol sedoanalgesia may be con- sidered preferable because it is associated with shorter recovery time, adequate post procedure analgesia, wi- thout any significant adverse effects on cardiovascular and respiratory parameters and is a practical alternative in paediatric patients undergoing lower GI endoscopies for monitored anesthesia care.

Keywords

• procedural sedation
• monitored anesthesia care
• pediatric patients
• lower gi endoscopy
• colono- scopy
• dexmedetomidine
• propofol
• fentanyl