Comparison of the safety and effectiveness of the use of Dexmedetomidine-Fentanyl Vs Propofol-Fentanyl for gastrointestinal endoscopic procedures
The combination Dexmedetomidine-Fentanyl (D) will attempt to reduce hemodynamic changes and intensity of adverse reactions (AR) compared to Propofol-Fentanyl (P) for gastrointestinal endoscopic procedures: Digestive video endoscopies (VEDA), Colonoscopies and endoscopic retrograde cholangiopan...
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| Autores principales: | , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/25685 |
| Aporte de: |
| Sumario: | The combination Dexmedetomidine-Fentanyl (D) will attempt to reduce hemodynamic changes and intensity of adverse reactions (AR) compared to Propofol-Fentanyl (P) for gastrointestinal endoscopic procedures: Digestive video endoscopies (VEDA), Colonoscopies and endoscopic retrograde cholangiopancreatography (ERCP).The objective was to assess the safety and efficacy of Dexmedetomidine and hemodynamic changes, assess analgesic quality and sedation, record oxygen desaturation events, assess the degree of patient satisfaction after the anesthetic act and recovery and identify AR.
Bioethical approval CIEIS Hospital Córdoba. Randomized, prospective, double-blind, randomized clinical trial, 60 patients in two groups, Group P: Propofol-Fentanyl, 1mcg / kg Fentanyl and Propofol 1mg / kg and boluses 0.5mg to 1mg / kg. Group D: Dexmedetomidine-Fentanyl, 1mcg / kg Fentanyl and loading Dexmedetomidine 1mcg / kg in 10 minutes and infusion 0.3 to 0.7 mcg / kg / hour. Inclusion criteria: 18-65 years, both sexes, ASA I-III, gastrointestinal endoscopies. Hemodynamic parameters were evaluated: Diastolic blood pressure (ADT), Systolic blood pressure (ASD), Mean Arterial Blood Pressure (ASD), Heart Rate (HR) and Oxygen Saturation (SpO2%); sedation, analgesia, AR, satisfaction and recovery. Fisher's LSD Test, Comparison test of proportions of each category, Wilcoxon test, Kruskal Wallis tests, Chi square independence test were applied. All cases p <0.05.
D presented higher values of TAS, TAD, TAM and SO2%, while P presented significantly higher HR values. The level of sedation was significantly higher at the end of the procedure for P. The analgesic quality D recorded greater events of intolerance to the introduction of the endoscope in ERCP. The most frequent AR were significantly to D Bradycardia and arterial hypertension, to P isolated respiratory depression and occasionally associated with arterial hypotension and bradycardia. In anesthetic recovery, P presented arterial hypotension and dizziness more frequently. The level of satisfaction and recovery with Aldrete 10/10 did not show significant differences.
The results show that Dexmedetomidine-Fentanyl produces a lower incidence of respiratory depression, less adverse reactions and greater hemodynamic stability. The effective dose for ERCP should still be determined.
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