Percutaneous endoscopic gastrostomy under conscious sedation

• Published in: Ain-Shams journal of anesthesiology 2015-04, Vol.8 (2), p.223-229
• Main Authors: Lutfi, Muhammad A., al-Kalla, Rihab, Ayyad, Muhammad
• Format: Article
• Language: English
• Subjects: Conscious sedation; Dexmedetomidine; Percutaneous endoscopic gastrostomy
• ISSN: 1687-7934; 2090-925X
• DOI: 10.4103/1687-7934.156693

Background Dexmedetomidine may be appropriate for painful procedures as a conscious sedation because of its sedative and analgesic properties. Percutaneous endoscopic gastrostomy ( PEG) is mildly painful and thus may need conscious sedation. Hence, in this trial we aimed to evaluate the effi cacy of propofol in comparison with dexmedetomidine for conscious sedation during PEG. Patients and methods Forty-four patients between 40 and 60 years old were included in the study. Patients undergoing elective PEG were randomly assigned to either the dexmedetomidine group or the propofol group. All patients received fentanyl 1 μg/kg, intravenous, 10 min before the procedure. An initial loading dose of 1 μg/kg dexmedetomidine was administered intravenously over 10 min to patients in group I (n = 22) before the procedure and as a continuous infusion dose of 0.2 μg/kg/h just before the procedure started. In group II (n = 22) propofol was infused at 4 mg/kg/h for 10 min, followed by infusion of 2 mg/kg/h. The visua l analog scale was used to evaluate pain intensity at 5-min intervals during PEG (15–30 min). The Observer’s Assessment of Alertness/Sedation was used to evaluate the sedation degree. Hemodynamic and respiratory variables and the Observer’s Assessment of Alertness/Sedation scores were regularly recorded during PEG at 5-min intervals (35 min) and to 90 min after. Results Forty-four patients were evaluated. In the dexmedetomidine group, visual analog scale values were signifi cantly lower than those in the propofol group at the 20–35 min assessments (P < 0.05). During sedation, the respiratory rate was signifi cantly lower in the dexmedetomidine group; however, SpO2 was signifi cantly higher than that in the propofol group (P < 0.05). Conclusion Dexmedetomidine provides more efficient hemodynamic stability, higher Observer’s Assessment of Alertness/Sedation, higher satisfaction scores, and lowe r visual analog scale scores. According to our results we believe that dexmedetomidine can be safely used as a sedoanalgesic agent in PEG.