A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial.

Author(s): Kaygusuz K, Gokce G, Gursoy S, Ayan S, Mimaroglu C, Gultekin Y

Affiliation(s): Department of Anesthesiology, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey. kaygusuz@cumhuriyet.edu.t.

Publication date & source: 2008-01, Anesth Analg., 106(1):114-9, table of contents.

Publication type:

BACKGROUND: Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracorporeal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure. METHODS: Forty-six patients were randomly allocated into two groups to receive either dexmedetomidine or propofol for elective ESWL. Dexmedetomidine was infused at 6 mug . kg(-1) . h(-1) for 10 min followed by an infusion rate of 0.2 mug . kg(-1) . h(-1). Propofol was infused at 6 mg . kg(-1) . h(-1) for 10 min followed by an infusion of 2.4 mg . kg(-1) . h(-1). Fentanyl 1 mug/kg IV was given to all patients 10 min before ESWL. Pain intensity was evaluated with a visual analog scale at 5-min intervals during ESWL (10-35 min). Sedation was determined using the Observer's Assessment of Alertness/Sedation. The Observer's Assessment of Alertness/ Sedation scores and hemodynamic and respiratory variables were recorded regularly during ESWL (35 min) and up to 85 min after. RESULTS: Forty patients were evaluated. Visual analog scale values with dexmedetomidine were significantly lower than those with propofol only at the 25-35 min assessments (P < 0.05). During sedation, the respiratory rate with dexmedetomidine was significantly slower but Spo(2) was significantly higher than with propofol (P < 0.05). Other clinical variables were similar (P > 0.05). CONCLUSION: A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.