Efficacy of Different Dose of Dexmedetomidine Combined With Remifentanil in Colonoscopy

A Randomized Controlled Trial

Li Jia; Meng Xie; Jing Zhang; Jingyu Guo; Tong Tong; Yuying Xing

Disclosures

BMC Anesthesiol. 2020;20(225) 

In This Article

Background

Colonoscopy can be performed for the screening of cancer, adenomas, and polyps, for the assessment of known or possible bleeding, and for the evaluation of possible causes of abdominal pain, gastrointestinal symptoms, and/or changes in bowel habits.[1,2] The National Colorectal Cancer Roundtable aims to reach 80% screening prevalence in the eligible American population,[3,4] representing 5.1 million colonoscopies each year.[5]

Beyond the discomfort and inconveniences associated with bowel preparation,[6] colonoscopy is associated with discomfort and sometimes pain. At present, the commonly used methods are the intravenous injection of propofol, etomidate, ketamine, and other drugs to make the patient's unconscious.[7] The disadvantage is that the patient cannot cooperate during the examination (e.g., for changing position), and medical staff is needed to assist in turning over the patient, if necessary. This may compress the patient's stomach and abdomen, which may cause gastric reflux and aspiration, which may cause pneumonia, with morbidity and even mortality.[8,9]

Dexmedetomidine (DEX) is a new type of highly selective α2 receptor agonist. It has sedative, analgesic, and anxiolytic effects, and is known as a "wake-up sedative". Compared with propofol and fentanyl, it provides sedation without the risk of respiratory depression and can provide cooperative or semi-rousable sedation.[10,11] It has incomparable advantages during colonoscopy as it allows the patient to cooperate during the procedure.[12–15] Dexmedetomidine can be used with other drugs such as remifentanil to achieve deeper sedation, but few studies examined the dexmedetomidine-remifentanil combination for colonoscopy.

Therefore, this study aimed to evaluate the effects of dexmedetomidine combined with remifentanil at different doses for colonoscopy. The results could provide clues about the most optimal doses and improve the patient experience of colonoscopy.

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