Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.12.002
Brazilian Journal of Anesthesiology
Systematic Review

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Francisca Jerónimo Fonseca, Leonardo Ferreira, Ana Lídia Rouxinol-Dias, Joana Mourão

Downloads: 2
Views: 105

Abstract

Background: Dexmedetomidine (DEX) is an a2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population.
Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others.
Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%).

Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.

Keywords

Anesthesiology; Conscious sedation; Dexmedetomidine; Hypnotics and sedatives; Patient safety

References

1. Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011;5:128 −33.
2. Morelli A, Sanfilippo F, Arnemann P, et al. The effect of propofol and dexmedetomidine sedation on norepinephrine requirements in septic shock patients: a crossover trial. Crit Care Med. 2019;47:e89−95.
3. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol. 2008;4:619−27.
4. Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol. 2018;35:6−24.
5. Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth.
2015;115:171−82.
6. Barends CR, Absalom A, van Minnen B, Vissink A, Visser A. Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety. PLoS One. 2017;12: e0169525.
7. Lin Y, Zhang R, Shen W, et al. Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth. 2020;62:109736.
8. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;350: g7647.
9. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.  
10. Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj. 2019;366: l4898.
11. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557−60.
12. Higgins JP, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.
13. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22:276−82.
14. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
15. Nooh N, Sheta SA, Abdullah WA, Abdelhalim AA. Intranasal atomized dexmedetomidine for sedation during third molar extraction. Int J Oral Maxillofac Surg. 2013;42:857−62.
16. Shetty SK, Aggarwal G. Efficacy of intranasal dexmedetomidine for conscious sedation in patients undergoing surgical removal of impacted third molar: a double-blind split mouth study. J Maxillofac Oral Surg. 2016;15:512−6.
17. Hiwarkar S, Kshirsagar R, Singh V, et al. Comparative evaluation of the intranasal spray formulation of midazolam and dexmedetomidine in patients undergoing surgical removal of impacted mandibular third molars: a split mouth prospective study. J Maxillofac Oral Surg. 2018;17:44−51.
18. Candiotti KA, Bergese SD, Bokesch PM, et al. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg.
2010;110:47−56.
19. Gunduz M, Sakalli S, Gunes Y, Kesiktas E, Ozcengiz D, Isik G. Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients. J Anaesthesiol Clin Pharmacol. 2011;27:220−4.
20. Kundra P, Velayudhan S, Krishnamachari S, Gupta SL. Oral ketamine and dexmedetomidine in adults' burns wound dressing - A randomized double blind cross over study. Burns. 2013;39:1150−6.
21. Ravipati P, Reddy PN, Kumar C, Pradeep P, Pathapati RM, Rajashekar ST. Dexmedetomidine decreases the requirement of ketamine and propofol during burns debridement and dressings.  Indian J Anaesth. 2014;58:138−42.
22. Zor F, Ozturk S, Bilgin F, Isik S, Cosar A. Pain relief during dressing changes of major adult burns: ideal analgesic combination with ketamine. Burns. 2010;36:501−5.
23. Cheung CW, Ying CL, Chiu WK, Wong GT, Ng KF, Irwin MG. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia. 2007;62:1132−8.
24. Cheung CW, Ng KFK, Liu J, Yuen MYV, Ho MHA, Irwin MG. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br J Anaesth. 2011;107:430−7.
25. Cheung CW, Ng KFJ, Choi WS, et al. Evaluation of the analgesic efficacy of local dexmedetomidine application. Clin J Pain. 2011;27:377−82.
26. Fan TW, Ti LK, Islam I. Comparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index. Br J Oral Maxillofac Surg. 2013;51:428 −33.
27. Kawaai H, Tomita S, Nakaike Y, Ganzberg S, Yamazaki S. Intravenous sedation for implant surgery: midazolam, butorphanol, and dexmedetomidine versus midazolam, butorphanol, and propofol. J Oral Implantol. 2014;40:94−102.
28. Mishra N, Birmiwal KG, Pani N, Raut S, Sharma G, Rath KC. Sedation in oral and maxillofacial day care surgery: a comparative study between intravenous dexmedetomidine and midazolam. Natl J Maxillofac Surg. 2016;7:178−85.
29. Nolan PJ, Delgadillo JA, Youssef JM, Freeman K, Jones JL, Chehrehsa A. Dexmedetomidine provides fewer respiratory events compared with propofol and fentanyl during third molar surgery: a randomized clinical trial. J Oral Maxillofac Surg. 2020;78:1704−16.
30. Rasheed MA, Punera DC, Bano M, Palaria U, Tyagi A, Sharma S. A study to compare the overall effectiveness between midazolam and dexmedetomidine during monitored anesthesia care: a randomized prospective study. Anesth Essays Res. 2015;9:167−72.
31. Salazar Merchan A. Sedacion analgesia con dexmedetomidina comparada con propofol en Procedimientos de cirugía bucal. Acta Odontologica Venezolana. 2008;46:487−94.
32. Sivasubramani SM, Pandyan DA, Chinnasamy R, Kuppusamy SK. Comparison of bite force after administration of midazolam and dexmedetomidine for conscious sedation in minor oral surgery. J Pharm Bioallied Sci. 2019;11:S446−s9.
33. Taniyama K, Oda H, Okawa K, Himeno K, Shikanai K, Shibutani T. Psychosedation with dexmedetomidine hydrochloride during minor oral surgery. Anesth Prog. 2009;56:75−80.

34. Taylor DC, Ferguson HW, Stevens M, Kao S, Yang FM, Looney S. Does including dexmedetomidine improve outcomes after intravenous sedation for outpatient dentoalveolar surgery? J Oral Maxillofac Surg. 2020;78:203−13.
35. Togawa E, Hanamoto H, Maegawa H, Yokoe C, Niwa H. Dexmedetomidine and midazolam sedation reduces unexpected patient movement during dental surgery compared with propofol and midazolam sedation. J Oral Maxillofac Surg. 2019;77:29−41.
36. Wang LZ Y, Zhang T, Huang L, Peng W. Comparison in sedative effects between dexmedetomidine and midazolam in dental implantation: a randomized clinical trial. Biomed Res Int. 2020;2020:6130162.
37. Yu C, Li S, Deng F, Yao Y, Qian L. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction. Int J Oral
Maxillofac Surg. 2014;43:1148−53.
38. Akarsu Ayazoglu T, Polat E, Bolat C, et al. Comparison of propofol-based sedation regimens administered during colonoscopy. Rev Med Chil. 2013;141:477−85.
39. Amri P, Nahrini S, Hajian-Tilaki K, et al. Analgesic effect and hemodynamic changes due to dexmedetomidine versus fentanyl during elective colonoscopy: a double-blind randomized clinical trial. Anesth Pain Med. 2018;8:e81077.
40. Bavullu EN, Aksoy E, Abdullayev R, Gogu¸s N, Dede D. Comparison of dexmedetomidine and midazolam in sedation for percutaneous drainage of hepatic hydatid cysts. Turk J Anaesthesiol Reanim. 2013;41:195−9.
41. Cheung CW, Qiu Q, Liu J, Chu KM, Irwin MG. Intranasal dexmedetomidine in combination with patient-controlled sedation during upper gastrointestinal endoscopy: a randomised trial. Acta Anaesthesiol Scand. 2015;59:215−23.
42. Cho JS, Soh S, Kim EJ, et al. Comparison of three sedation regimens for drug-induced sleep endoscopy. Sleep Breath. 2015;19:711−7.
43. Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: a prospective, randomized study. Can J Gastroenterol. 2007;21:25−9.
44. Dere K, Sucullu I, Budak ET, et al. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol. 2010;27:648−52. 
45. Eberl S, Preckel B, Bergman JJ, van Dieren S, Hollmann MW. Satisfaction and safety using dexmedetomidine or propofol sedation during endoscopic oesophageal procedures: a randomised controlled trial. Eur J Anaesthesiol. 2016;33:631−7.
46. Eldesuky Ali Hassan HI. Dexmedetomidine versus ketofol for moderate sedation in endoscopic retrograde cholangiopancreatography (ERCP) comparative study. Egypt J Anaesth. 2015;31:15−21.
47. Elkalla RS, El Mourad MB. Respiratory and hemodynamic effects of three different sedative regimens for drug induced sleep endoscopy in sleep apnea patients. A prospective randomized study. Minerva Anestesiol. 2020;86:132−40.
48. Goyal R, Hasnain S, Mittal S, Shreevastava S. A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP. Gastrointest Endosc. 2016;83:928−33.
49. Hashiguchi K, Matsunaga H, Higuchi H, Miura S. Dexmedetomidine for sedation during upper gastrointestinal endoscopy. Dig Endosc. 2008;20:178−83.
50. Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdzik P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology. 2005;103:269−73.

51. Karanth H, Murali S, Koteshwar R, Shetty V, Adappa K. Comparative study between propofol and dexmedetomidine for conscious sedation in patients undergoing outpatient colonoscopy. Anesth Essays Res. 2018;12:98−102. 
52. Kilic N, Sahin S, Aksu H, et al. Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. Eurasian J Med. 2011;43:13−7.
53. Kim N, Yoo YC, et al. Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection. World J Gastroenterol. 2015;21:3671−8.
54. Kinugasa H, Higashi R, Miyahara K, et al. Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study. Clin Transl Gastroenterol. 2018;9:167.
55. Koruk S, Koruk I, Arslan AM, Bilgi M, Gul R, Bozgeyik S. Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study. Wideochir Inne Tech Maloinwazyjne. 2020;15:526−32.
56. Kuyrukluy{ld{z U, Binici O, Onk D, et al. Comparison of dexmedetomidine and propofol used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome. Int J Clin Exp Med. 2015;8:5691−8.
57. Lee BS, Ryu J, Lee SH, et al. Midazolam with meperidine and dexmedetomidine vs. midazolam with meperidine for sedation during ERCP: prospective, randomized, double-blinded trial. Endoscopy. 2014;46:291−8.
58. Lee SP, Sung IK, Kim JH, et al. Comparison of dexmedetomidine with on-demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor. J Dig Dis. 2015;16:377−84.
59. Lu Z, Li W, Chen H, Qian Y. Efficacy of a dexmedetomidine −remifentanil combination compared with a midazolam −remifentanil combination for conscious sedation during therapeutic endoscopic retrograde cholangio-pancreatography: a prospective, randomized, single-blinded preliminary trial. Dig Dis Sciences. 2018;63:1633−40.
60. Mazanikov M, Udd M, Kyl€anp€a€a L, et al. Dexmedetomidine impairs success of patient-controlled sedation in alcoholics during ERCP: a randomized, double-blind, placebo-controlled study. Surg Endosc Interv Tech. 2013;27:2163−8.
61. Mukhopadhyay S, Niyogi M, Sarkar J, Mukhopadhyay BS, Halder SK. The dexmedetomidine "augmented" sedato analgesic cocktail: an effective approach for sedation in prolonged endoscopic retrograde cholangio-pancreatography. J Anaesthesiol Clin Pharmacol. 2015;31:201−6.
62. Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc. 2008;67:651−9.
63. Nonaka T, Inamori M, Miyashita T, et al. Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection? Endosc Int Open. 2018;6:E3−e10.
64. Padiyara TV, Bansal S, Jain D, Arora S, Gandhi K. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope. 2020;130:257−62.
65. Pushkarna G, Sarangal P, Pushkarna V, Gupta R. Comparative evaluation of dexmedetomidine versus midazolam as premedication to propofol anesthesia in endoscopic retrograde cholangiopancreatography. Anesth Essays Res. 2019;13:297−302.
66. Ramkiran S, Iyer SS, Dharmavaram S, Mohan CV, Balekudru A, Kunnavil R. BIS targeted propofol sparing effects of dexmedetomidine versus ketamine in outpatient ERCP: a prospective randomised controlled trial. J Clin Diagn Res. 2015;9: Uc07−12.

67. Takimoto K, Ueda T, Shimamoto F, et al. Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer. Dig Endosc. 2011;23:176−81.
68. Trivedi SK R, Tripathi AK, Mehta RK. A comparative study of dexmedetomidine and midazolam in reducing delirium caused by ketamine. J Clin Diagn Res. 2016;10:Uc01−4.
69. Wu Y, Zhang Y, Hu X, Qian C, Zhou Y, Xie J. A comparison of propofol vs. dexmedetomidine for sedation, haemodynamic control and satisfaction, during esophagogastroduodenoscopy under conscious sedation. J Clin Pharm Ther. 2015;40:419−25. 
70. Elnabtity AM, Selim MF. A prospective randomized trial comparing dexmedetomidine and midazolam for conscious sedation during oocyte retrieval in an in vitro fertilization
program. Anesth Essays Res. 2017;11:34−9.
71. Sethi P, Sindhi S, Verma A, Tulsiani KL. Dexmedetomidine versus propofol in dilatation and curettage: an open-label pilot randomized controlled trial. Saudi J Anaesth. 2015;9:258−62.
72. Alizadehasl A, Sadeghpour A, Totonchi Z, Azarfarin R, Rahimi S, Hendiani A. Comparison of sedation between dexmedetomidine and propofol during transesophageal echocardiography: a randomized controlled trial. Ann Card Anaesth. 2019;22:285−90.
73. Cho JS, Shim JK, Na S, Park I, Kwak YL. Improved sedation with dexmedetomidine-remifentanil compared with midazolamremifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial. Europace. 2014;16:1000−6. 
74. Cooper L, Candiotti K, Gallagher C, Grenier E, Arheart KL, Barron ME. A randomized, controlled trial on dexmedetomidine for providing adequate sedation and hemodynamic control for awake, diagnostic transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2011;25:233−7.
75. Khalil M, Al-Agaty A, Asaad O, et al. A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation. J Clin Anesth. 2016;32:242−7.
76. Prachanpanich N, Apinyachon W, Ittichaikulthol W, Moontripakdi O, Jitaree A. A comparison of dexmedetomidine and propofol in Patients undergoing electrophysiology study. J Med Assoc Thai. 2013;96:307−11.
77. Sairaku A, Yoshida Y, Hirayama H, Nakano Y, Ando M, Kihara Y. Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial. Europace. 2014;16:994−9.
78. Sruthi S, Mandal B, Rohit MK, Puri GD. Dexmedetomidine versus ketofol sedation for outpatient diagnostic transesophageal echocardiography: a randomized controlled study. Ann Card Anaesth. 2018;21:143−50.
79. Loh P-S, Ariffin MA, Rai V, Lai L-L, Chan L, Ramli N. Comparing the efficacy and safety between propofol and dexmedetomidine for sedation in claustrophobic adults undergoing magnetic resonance imaging (PADAM trial). J Clin Anesth. 2016;34: 216−22.
80. Kim SY, Chang CH, Lee JS, et al. Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia  with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis: a prospective, randomized study. J Vasc Interv Radiol. 2013;24:779−86.
81. Ren C, Gao J, Xu GJ, et al. The nimodipine-sparing effect of perioperative dexmedetomidine infusion during aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial. Front Pharmacol. 2019;10:858.
82. Sriganesh K, Reddy M, Jena S, Mittal M, Umamaheswara Rao GS. A comparative study of dexmedetomidine and propofol as sole sedative agents for patients with aneurysmal subarachnoid hemorrhage undergoing diagnostic cerebral angiography. J Anesth. 2015;29:409−15.

83. Masoumi K, Maleki SJ, Forouzan A, Delirrooyfard A, Hesam S. Dexmedetomidine versus midazolam-fentanyl in procedural analgesia sedation for reduction of anterior shoulder dislocation: a randomized clinical trial. Rev Recent Clin Trials. 2019;14:269−74.
84. Sannakki D, Dalvi NP, Sannakki S, Parikh DP, Garg SK, Tendolkar B. Effectiveness of dexmedetomidine as premedication prior to electroconvulsive therapy, a Randomized controlled cross over study. Indian J Psychiatry. 2017;59:370−4.
85. El Mourad MB, Elghamry MR, Mansour RF, Afandy ME. Comparison of intravenous dexmedetomidine-propofol versus ketofol for sedation during awake fiberoptic intubation: a
prospective, randomized study. Anesth Pain Med. 2019;9: e86442.
86. Goneppanavar U, Magazine R, Periyadka Janardhana B, Krishna Achar S. Intravenous dexmedetomidine provides superior patient comfort and tolerance compared to intravenous midazolam in patients undergoing flexible bronchoscopy. Pulm Med. 2015;2015:727530.
87. Gu W, Xu M, Lu H, Huang Q, Wu J. Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial. J Thorac Dis. 2019;11:4663−70.
88. Liao W, Ma G, Su QG, Fang Y, Gu BC, Zou XM. Dexmedetomidine versus midazolam for conscious sedation in postoperative patients undergoing flexible bronchoscopy: a randomized study. J Int Med Res. 2012;40:1371−80. 
89. Ma XX, Fang XM, Hou TN. Comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during coblation-assisted upper airway procedure. Chin Med J (Engl). 2012;125:869−73.
90. Magazine R, Venkatachala SK, Goneppanavar U, Surendra VU, Guddattu V, Chogtu B. Comparison of midazolam and low-dose dexmedetomidine in flexible bronchoscopy: a prospective, randomized, double-blinded study. Indian J Pharmacol. 2020;52:23−30.
91. Riachy M, Khayat G, Ibrahim I, et al. A randomized double-blind controlled trial comparing three sedation regimens during flexible bronchoscopy: dexmedetomidine, alfentanil and lidocaine. Clin Respir J. 2018;12:1407−15.
92. Ryu JH, Lee SW, Lee JH, Lee EH, Do SH, Kim CS. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth. 2012;108:503−11.
93. St-Pierre P, Tanoubi I, Verdonck O, et al. Dexmedetomidine versus remifentanil for monitored anesthesia care during endobronchial ultrasound-guided transbronchial needle aspiration: a randomized controlled trial. Anesth Analg. 2019;128:98−106.
94. Wu SH, Lu DV, Hsu CD, Lu IC. The effectiveness of low-dose dexmedetomidine infusion in sedative flexible bronchoscopy: a retrospective analysis. Medicina (Kaunas). 2020;56:193.
95. Yuan F, Fu H, Yang P, et al. Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: a randomized study. Exp Ther Med. 2016;12:506−12.
96. Ak¸ca B, Aydogan-Eren E, Canbay €O, et al. Comparison of efficacy of prophylactic ketamine and dexmedetomidine on postoperative
bladder catheter-related discomfort. Saudi Med J. 2016;37:55−9.
97. Alhashemi JA, Kaki AM. Dexmedetomidine in combination with morphine PCA provides superior analgesia for shockwave lithotripsy. Can J Anaesth. 2004;51:342−7.
98. Arpaci AH, Bozkirli F. Comparison of sedation effectiveness of remifentanil-dexmedetomidine and remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: a randomized clinical trial. J Res Med Sci. 2013;18:107−14.
99. Kaygusuz K, Gokce G, Gursoy S, Ayan S, Mimaroglu C, Gultekin Y. A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial. Anesth Analg. 2008;106:114−9.
100. Kumakura Y, Ishiyama T, Matsuoka T, Iijima T, Matsukawa T. Effects of spinal anesthesia and sedation with dexmedetomidine or propofol on cerebral regional oxygen saturation and systemic oxygenation a period after spinal injection. J Anesth. 2020;34:806−13.
101. Modir H, Moshiri E, Yazdi B, Kamalpour T, Goodarzi D, Mohammadbeigi A. Efficacy of dexmedetomidine-ketamine vs. fentanylketamine on saturated oxygen, hemodynamic responses and sedation in cystoscopy: a doubleblinded randomized controlled clinical trial. Med Gas Res. 2020;10:91−5.
102. Shariffuddin II, Teoh WH, Wahab S, Wang CY. Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study. BMC Anesthesiol. 2018;18:3.
103. Tan WF, Miao EY, Jin F, Ma H, Lu HW. Changes in first postoperative night bispectral index after daytime sedation induced by dexmedetomidine or midazolam under regional anesthesia: a randomized controlled trial. Reg Anesth Pain Med. 2016;41:380−6.
104. Zeyneloglu P, Pirat A, Candan S, Kuyumcu S, Tekin I, Arslan G. Dexmedetomidine causes prolonged recovery when compared with midazolam/fentanyl combination in outpatient shock wave lithotripsy. Eur J Anaesthesiol. 2008;25:961−7.
105. Huncke TK, Adelman M, Jacobowitz G, Maldonado T, Bekker A. A prospective, randomized, placebo-controlled study evaluating the efficacy of dexmedetomidine for sedation during vascular procedures. Vasc Endovascular Surg. 2010;44:257−61.
106. Samantaray A. Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion. Indian J Anaesth. 2014;58:281−6.
107. Samantaray A, Hanumantha Rao M, Sahu CR. Additional analgesia for central venous catheter insertion: a placebo controlled randomized trial of dexmedetomidine and fentanyl. Crit Care Res Pract. 2016;2016:9062658.
108. Sivasubramani S, Pandyan DA, Ravindran C. Comparision of vital surgical parameters, after administration of midazolam and dexmedetomidine for conscious sedation in minor oral surgery. Ann Maxillofac Surg. 2019;9:283−8.
109. Wu W, Chen Q, Zhang LC, Chen WH. Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy. J Int Med Res. 2014;42:516−22.
110. Wu LP, Kang WQ. Effect of dexmedetomidine for sedation and cognitive function in patients with preoperative anxiety undergoing carotid artery stenting. J Int Med Res.
2020;48:300060520938959.
111. Yin S, Hong J, Sha T, et al. Efficacy and tolerability of sufentanil, dexmedetomidine, or ketamine added to propofol-based sedation for gastrointestinal endoscopy in elderly patients: a prospective, randomized, controlled trial. Clin Ther. 2019;41:1864−77. e0.
112. Barbosa FT, Lira AB, Neto OBdO, et al. Tutorial for performing systematic review and meta-analysis with interventional anesthesia studies. Br J Anaesth. (English Edition).
2019;69:299−306.
113. Newman DH, Azer MM, Pitetti RD, Singh S. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1,367 pediatric procedural sedations. Ann Emerg Med. 2003;42:627−35.
114. Mason KP, Green SM, Piacevoli Q. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force. Br J Anaesth. 2012;108:13−20.
115. Jayaraman L, Sethi N, Sood J. Anaesthesia outside the operating theatre. Update in Anaesth. 2009;25:37−41.


Submitted date:
04/07/2021

Accepted date:
12/05/2021

62169788a9539518f97c7fd3 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections