Abstracts submitted to ASGE 2010M1537: The Use of Dexmedetomidine for Gastrointestinal Endoscopic Procedures in Difficult to Sedate Cohort: A Single Institution Experience
Section snippets
Background and Aim
Dexmedetomidine (Dx) is a novel alpha-2 adrenoceptor agonist with sedative and analgesic properties. Reports on its use in gastrointestinal endoscopies (GIE) are limited. We report a retrospective review of the use of Dx in GIE from 1/2007 to 10/2009. The aim of the study is to assess procedure completion and adverse event rates.
Methods
A total of 129 procedures with Dx were performed on 89 patients (54 female: 35 male) with mean (range) age of 50±16 (21-85) years. Of the total patients, 29% had failed prior sedation, 69% were expected to have difficult sedation or prolonged procedure, and 70% were on narcotics at the time of procedure. Dx was given intravenously as a bolus at 1mcg/kg over 5 minutes and was maintained at varying rates. After the bolus, meperidine/fentanyl and midazolam were also given at varying doses.
Results
ERCP, EUS, and single-balloon enteroscopy accounted for 61% of the procedures while EGD, colonoscopy, and PEG/PEJ accounted for the remainder. The mean sedative dosages, procedure time, and recovery time are shown in Table 1. Procedure completion rate was 94%. Higher Dx maintenance rate was observed in successfully completed cases as compared to failed sedation cases, 0.82±0.50 vs. 0.43±0.26 mcg/kg/hr (p=0.049). Those with prolonged recovery time (>2 hours) received higher Dx dose as compared
Conclusion
Despite prolonged recovery time and increased reversible adverse events, the use of Dx along with standard sedatives for GIE was associated with excellent procedural completion rate in our difficult to sedate cohort.