Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: Randomized, single-blind, controlled trial

Seongjoo Park, Soo-Lyoen Choi, Francis Sahngun Nahm, Jung-Hee Ryu, Sang-Hwan Do, Seongjoo Park, Soo-Lyoen Choi, Francis Sahngun Nahm, Jung-Hee Ryu, Sang-Hwan Do

Abstract

Background: Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy.

Methods: Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 μg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared.

Results: A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups.

Conclusion: The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram. Seventy patients were randomized; 1 patient from group P was excluded due to conversion to general anesthesia.
Figure 2
Figure 2
Intraoperative changes in the mean arterial pressure and heart rate. The mean arterial pressure before the start of the operation and immediately after the start of the operation was significantly higher in group D compared with group P. Also, the intraoperative heart rate was significantly lower in group D than in group P. BPM = beats per minute.
Figure 3
Figure 3
Postoperative changes in mean arterial pressure and heart rate. In the PACU, the mean arterial pressure and heart rate were significantly lower in group D compared with group P. BPM = beats per minute, PACU - post-anesthetic care unit.

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